By Kathryn E. Roberts, RN, MSN, CNS, CCRN, CCNS, Christopher P. Bonafide, MD, MSCE, Christine Weirich Paine, MPH, Breah Paciotti, MPH, Kathleen M. Tibbetts, MS, Ron Keren, MD, MPH, Frances K. Barg, PhD, and John H. Holmes, PhD Background Rapid response systems (RRSs) aim to identify and rescue hospitalized patients whose condition is deteriorat- ing before respiratory or cardiac arrest occurs. Previous studies of RRS implementation have shown variable effectiveness, which may be attributable in part to barriers preventing staff from activating the system. Objective To proactively identify barriers to calling for urgent assistance that exist despite recent implementation of a com- prehensive RRS in a children’s hospital. Methods Qualitative study using open-ended, semistructured interviews of 27 nurses and 30 physicians caring for patients in general medical and surgical care areas. Results The following themes emerged: (1) Self-efficacy in recognizing deteriorating conditions and activating the medical emergency team (MET) were considered strong determinants of whether care would be appropriately escalated for children in a deteriorating condition. (2) Intraprofessional and interpro- fessional hierarchies were sometimes challenging to navigate and led to delays in care for patients whose condition was dete- riorating. (3) Expectations of adverse interpersonal or clinical outcomes from MET activations and intensive care unit transfers could strongly shape escalation-of-care behavior (eg, reluctance among subspecialty attending physicians to transfer patients to the intensive care unit for fear of inappropriate management). Conclusion s The results of this study provide an in-depth descrip- tion of the barriers that may limit RRS effectiveness. By recog- nizing and addressing these barriers, hospital leaders may be able to improve the RRS safety culture and thus enhance the impact of the RRS on rates of cardiac arrest, respiratory arrest, and mortality outside the intensive care unit. (American Journal of Critical Care. 2014;23:223-229) B ARRIERS TO CALLING FOR URGENT ASSISTANCE D ESPITE A C OMPREHENSIVE PEDIATRIC RAPID RESPONSE SYSTEM www.ajcconline.org AJCC AMERICAN JOURNAL OF CRITICAL CARE, May 2014, Volume 23, No. 3 223 ©2014 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ajcc2014594 Patient Safety Issues by guest on March 7, 2016 ajcc.aacnjournals.org Downloaded from