Introduction:
In free-standing pediatric hospitals, the Code Blue team may be activated for events in adults to provide triage, resuscitation, medical screening exams, EMTALA documentation and disposition decisions. However, activation of the Code Blue team can require significant time and critical care resources and may delay patient care if the activation is external to the building.
Hypothesis:
Development of a small triage team focused on specific adult triage algorithms will provide a safe, effective and efficient alternative to Code Blue team response.
Methods:
407 bed tertiary pediatric hospital, within metropolitan area. Collaborative multi-disciplinary QI process to design and simulate the roles, workflow and documentation of the Medical Emergency Team (MET). Education and communication to hospital-wide staff on MET, as well as MET responders completion of Advanced Cardiac Life Support course. Collaboration with local EMS leadership to coordinate transfer of patient was also undertaken.
Results:
MET roles were developed and two configurations of the MET team were implemented July 2018: one inside the footprint of the building and anther outside the footprint of the building, including the hospital grounds. The teams consisted of a mid-level provider, charge nurse, two security officers and a shift administrator: inside team relied on ICU provider and charge nurse, while outside team led by Emergency Medicine provider and charge nurse. Each team had a backpack with supplies, and transport gurney. Since inception, 199 activations occurred, 191 inside and 8 outside the facility. The activations included 45 staff or volunteers, 84 adult visitors, 75 pediatric visitors. Outcome for the activations: 57 transported to the hospital ED, 47 transported to another facility, 21 refused treatment and 68 had resolution of concerns. EMTALA documentation was complete in 112/137 (82%).
Conclusions:
Pediatric hospitals have substantial adult populations, where medical emergencies that arise rely on Code Blue in medical emergencies for simplicity. Development of a response team for nonpatients allows specific training, triage, and processes to improve care and reduce drain on ICU resources.
Predictive powers of the Modified Early Warning Score and the National Early Warning Score in general ward patients who activated the medical emergency team
