Implementation of a Pediatric Medical Emergency Team

Transition From a Traditional Code Team to a Medical Emergency Team and Categorization of Cardiopulmonary Arrests in a Children's Center

Hunt EA, Zimmer KP, Rinke ML, et al
Arch Pediatr Adolesc Med. 2008;162:117-122

Summary

Medical emergency teams (METs) have been implemented in adult hospital care in order to identify patients who are experiencing clinical deterioration before they reach the point of arrest. As such, these teams are often more multidisciplinary than traditional "code teams," and they are designed to empower care providers, including nurses, to get quick evaluation of any patient about whom they are worried.

This study evaluated historical data from one institution before and after implementation of a pediatric MET. The outcome of interest was the rate (per 1000 patient-days and per 1000 discharges) of cardiopulmonary or respiratory arrests before and after implementation of the pediatric MET.

Organizing the MET had several aspects that differed from previous code team approaches, including the fact that nurses were supported in their first-responder roles. Security guards and chaplains were on the team to handle family members so that nurses could be more involved in the MET evaluation and stabilization of the patients.

Perhaps the most significant change was the addition of a pediatric pharmacist to the MET. (There was no pharmacist on the code team.) Part of the implementation of the MET involved defining a set of criteria for which an MET could be called, and these ranged from "respiratory distress" to "worried family member," giving a lot of discretion to nursing when ordering an MET intervention. Education of all personnel to their new roles was also completed.

There were no differences in the number of patients admitted during the year pre-MET and the year post-MET implementation, and patient severity of illness was similar as well. The MET was activated more often than traditional code teams at a rate of 1.8 calls per 1000 patient-days compared with 1.1 calls per 1000 patient-days for code team activation.

The study authors found a 51% reduction in rate of respiratory arrest and cardiopulmonary arrest after MET implementation, but the difference was not statistically significant (95% confidence interval [CI] for the incidence rate ratio was 0.18-1.20). The rate of reduction in respiratory arrest alone almost reached statistical significance (incidence rate ratio 0.27, 95% CI 0.05-1.01).

The study authors concluded that implementation of the pediatric MET was associated with no change in rate of cardiopulmonary arrest but was associated with a reduced rate of respiratory arrest on the ward units.

Viewpoint

This article is very valuable for providing a road map of how to implement a change in emergency response in a children's hospital. However, the process also points out one of the biggest difficulties of quality improvement research. With such a multifaceted intervention (change in criteria and environment for activating the team, addition of a pharmacist, and education of all providers as to new roles -- to name just a few), it would be very difficult to determine which portion of the change provided the benefit. As more hospitals implement pediatric METs as a method to respond to emergencies, it will be interesting to see outcomes at other institutions.

Source : http://www.medscape.com/viewarticle/575965