Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results

• Published in: Archives of disease in childhood 2005-11, Vol.90 (11), p.1148-1152
• Main Authors: Tibballs, J, Kinney, S, Duke, T, Oakley, E, Hennessy, M
• Format: Article
• Language: English
• Subjects: Admission and discharge; Adults; Age; Anesthesia; Biological and medical sciences; Blood pressure; Cardiac arrest; Cardiac arrhythmia; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - standards; Child; Child, Preschool; Company business management; CPR; Critical Care - utilization; Emergencies; emergency department; Emergency medical care; Emergency medical services; Emergency Service, Hospital - organization & administration; Epidemiologic Methods; Evaluation; General aspects; Health Services Research; Heart Arrest - epidemiology; Heart Arrest - prevention & control; Heart Disorders; Heart rate; Hospital admission and discharge; Hospital Mortality; Hospitalization; Hospitals; Hospitals, Pediatric - organization & administration; Humans; ICU; Illnesses; Infant; Infant, Newborn; Intensive care; intensive care unit; Management; medical emergency team; Medical sciences; Medical Services; MET; Miscellaneous; Mortality; Nurses; Nursing; Original; Outcome and Process Assessment (Health Care); Palliative care; Patient Care Team - organization & administration; Patient outcomes; Patient Safety Committee; Patients; Pediatric emergencies; Pediatric intensive care; Physicians; Physiology; Prevention and actions; PSC; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality Assurance; Quality control; RCH; Registrars (School); Royal Children’s Hospital; Teaching Methods; Ventilation; Victoria - epidemiology
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.2004.069401

Aims: To determine the impact of a paediatric medical emergency team (MET) on cardiac arrest, mortality, and unplanned admission to intensive care in a paediatric tertiary care hospital. Methods: Comparison of the retrospective incidence of cardiac arrest and death during 41 months before introduction of a MET service with the prospective incidence of these events during 12 months after its introduction. Comparison of transgression of MET call criteria in patients who arrested and died before and after introduction of MET. Results: Cardiac arrest decreased from 20 among 104 780 admissions (0.19/1000) to 4 among 35 892 admissions (0.11/1000) (risk ratio 1.71, 95% CI 0.59 to 5.01), while death decreased from 13 (0.12/1000) to 2 (0.06/1000) during these periods (risk ratio 2.22, 95% CI 0.50 to 9.87). Unplanned admissions to intensive care increased from 20 (SD 6) to 24 (SD 9) per month. The incidence of transgression of MET call criteria in patients who arrested decreased from 17 to 0 (risk difference 0.16/1000, 95% CI 0.09 to 0.24), and in those who died, decreased from 12 to 0 (risk difference 0.11/1000, 95% CI 0.05 to 0.18) after introduction of MET. Conclusions: Introduction of a medical emergency team service was coincident with a reduction of cardiac arrest and mortality and a slight increase in admissions to intensive care.