Increased Mortality and Length of Stay Associated With Medical Emergency Team Review in Hospitalized Pediatric Patients

Introduction: There is a paucity of data regarding the association of pediatric patient characteristics with hospital mortality and transfer to higher levels of care following medical emergency team (MET) events. Objective: To explore associations of patient characteristics with hospital mortality and transfer to higher levels of care among pediatric patients who experienced a MET event during an admission. Methods: This retrospective observational study included data from patients aged ≤17 years admitted to an urban, tertiary hospital who experienced a MET event between 2014 and 2017. Data specific to the initial MET event for a patient were included for analysis. Multiple logistic regression models were used to test associations between patient characteristics (age, race, sex, ethnicity, timing of MET event, primary admission diagnosis, receiving care on specialized units) and each outcome separately. Results: Of the 366 patients eligible for inclusion, 11% (41 of 366) experienced hospital mortality, and 59% (216 of 366) were transferred to higher levels of care following MET events. Hospital mortality was lower among those who received emergency department care within 24 hours before the MET event compared to patients who did not (OR=0.17; 95% CI=0.04-0.82). Hospital mortality was higher among those with cardiac-related primary admission diagnoses compared to patients with noncardiac-related diagnoses (OR=3.44; 95% CI=1.04-11.39), and among those of unknown race compared to white patients (OR=3.14; 95% CI=1.17-8.48). No patient characteristics were associated with transfers to higher levels of care. Conclusions: While MET events may cause concern about failures to triage patients to appropriate levels of care upon admission, we observed that patients admitted from the emergency department within 24 hours before their MET event were more likely to survive to discharge. Higher hospital mortality following MET events was observed among patients with cardiac diagnoses and those of unknown race; more research is needed to understand how processes and documentation of care are related to these patients. Further study of how these characteristics and other potential confounding factors are associated with MET events and outcomes is warranted.

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Medical emergency team activation in patients pre- and post-liver transplantation is associated with prolonged length of stay and higher morbidity

Journal of Hepatology ◽

10.1016/s0168-8278(17)30668-2 ◽

2017 ◽

Vol 66 (1) ◽

pp. S189

Author(s):

M. Robertson ◽

W. Chung ◽

A. Huynh ◽

T. O’Halloran ◽

S. Warrillow ◽

...

Keyword(s):

Liver Transplantation ◽

Length Of Stay ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team ◽

Prolonged Length

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Characteristics and outcomes of children receiving intensive care therapy within 12 hours following a medical emergency team event

Critical Care and Resuscitation ◽

10.51893/2021.3.oa2 ◽

2021 ◽

Vol 23 (3) ◽

pp. 254-261

Author(s):

Ben Gelbart ◽

◽

Suzanna Vidmar ◽

David Stephens ◽

Daryl Cheng ◽

...

Keyword(s):

Intensive Care ◽

Length Of Stay ◽

Medical Emergency Team ◽

Risk Difference ◽

Respiratory Support ◽

Medical Emergency ◽

Critical Event ◽

Positive Pressure ◽

Intensive Care Therapy ◽

Emergency Team

OBJECTIVES: To describe characteristics and outcomes of children requiring intensive care therapy (ICT) within 12 hours following a medical emergency team (MET) event. DESIGN: Retrospective cohort study. SETTING: Quaternary paediatric hospital. PATIENTS: Children experiencing a MET event. MEASUREMENTS AND MAIN RESULTS: Between July 2017 and March 2019, 890 MET events occurred in 566 patients over 631 admissions. Admission to intensive care followed 183/890 (21%) MET events. 76/183 (42%) patients required ICT, defined as positive pressure ventilation or vasoactive support in intensive care, within 12 hours. Older children had a lower risk of requiring ICT than infants aged < 1 year (age 1–5 years [risk difference, -6.4%; 95% CI, -11% to -1.6%; P = 0.01] v age > 5 years [risk difference, -8.0%; 95% CI, -12% to -3.8%; P < 0.001]), while experiencing a critical event increased this risk (risk difference, 16%; 95% CI, 3.3–29%; P = 0.01). The duration of respiratory support and intensive care length of stay was approximately double in patients requiring ICT (ratio of geometric means, 2.0 [95% CI, 1.4–3.0] v 2.1 [95% CI, 1.5–2.8]; P < 0.001) and the intensive care mortality increased (risk difference, 9.6%; 95% CI, 2.4–17%; P = 0.01). Heart rate, oxygen saturation and respiratory rate were the most commonly measured vital signs in the 6 hours before the MET event. CONCLUSIONS: Approximately one-fifth of MET events resulted in intensive care admission and nearly half of these required ICT within 12 hours. This group had greater duration of respiratory support, intensive care and hospital length of stay, and higher mortality. Age < 1 year and a critical event increased the risk of ICT.

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An exploration of medical emergency team intervention at the end of life for people with advanced cancer

European Journal of Oncology Nursing ◽

10.1016/j.ejon.2017.10.005 ◽

2017 ◽

Vol 31 ◽

pp. 77-83 ◽

Cited By ~ 3

Author(s):

Christine Brown ◽

Allison Drosdowsky ◽

Meinir Krishnasamy

Keyword(s):

End Of Life ◽

Advanced Cancer ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team

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Comparison of policies for recognising and responding to clinical deterioration across five Victorian health services

Australian Health Review ◽

10.1071/ah16265 ◽

2018 ◽

Vol 42 (4) ◽

pp. 412 ◽

Cited By ~ 5

Author(s):

Julie Considine ◽

Anastasia F. Hutchison ◽

Helen Rawson ◽

Alison M. Hutchinson ◽

Tracey Bucknall ◽

...

Keyword(s):

Patient Safety ◽

Health Services ◽

Medical Emergency Team ◽

National Standards ◽

Clinical Deterioration ◽

Medical Emergency ◽

Emergency Team ◽

Subacute Care ◽

Guidance Documents ◽

Activation Criteria

Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to individual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.

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