A Multicenter Collaborative Approach to Reducing Pediatric Codes Outside the ICU

Hayes, Leslie; Dobyns, Emily L.; DiGiovine, Bruno; Brown, A; Jacobson, Sharon; Randall, Kelly H.; Wathen, Beth; Schwab, C.; Duncan, Kathleen; Thrasher, Jodi; Logsdon, Tina R.; Hall, Matthew; Markovitz, Barry P.

doi:10.1542/peds.2011-0227

Cited by 46 publications

(34 citation statements)

References 21 publications

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“…There was one feasibility and reliability testing study, one cost-analysis exercise, one protocol and one course evaluation survey. Of the 90 included papers, 45 focused on PEW detection systems, 2 3 6 7 10 14-53 29 examined PEW response mechanisms 8 54-81 and 16 reported on PEW implementation strategies [82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] (see online supplementary appendix 2 for a summary of these studies including the level of evidence and rationale for judgement).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

et al. 2017

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ObjectiveTo systematically review the available evidence on paediatric early warning systems (PEWS) for use in acute paediatric healthcare settings for the detection of, and timely response to, clinical deterioration in children.MethodThe electronic databases PubMed, MEDLINE, CINAHL, EMBASE and Cochrane were searched systematically from inception up to August 2016. Eligible studies had to refer to PEWS, inclusive of rapid response systems and teams. Outcomes had to be specific to the identification of and/or response to clinical deterioration in children (including neonates) in paediatric hospital settings (including emergency departments). 2 review authors independently completed the screening and selection process, the quality appraisal of the retrieved evidence and data extraction; with a third reviewer resolving any discrepancies, as required. Results were narratively synthesised.ResultsFrom a total screening of 2742 papers, 90 papers, of varied designs, were identified as eligible for inclusion in the review. Findings revealed that PEWS are extensively used internationally in paediatric inpatient hospital settings. However, robust empirical evidence on which PEWS is most effective was limited. The studies examined did however highlight some evidence of positive directional trends in improving clinical and process-based outcomes for clinically deteriorating children. Favourable outcomes were also identified for enhanced multidisciplinary team work, communication and confidence in recognising, reporting and making decisions about child clinical deterioration.ConclusionsDespite many studies reporting on the complexity and multifaceted nature of PEWS, no evidence was sourced which examined PEWS as a complex healthcare intervention. Future research needs to investigate PEWS as a complex multifaceted sociotechnical system that is embedded in a wider safety culture influenced by many organisational and human factors. PEWS should be embraced as a part of a larger multifaceted safety framework that will develop and grow over time with strong governance and leadership, targeted training, ongoing support and continuous improvement.

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Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

et al. 2017

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“…This project was coordinated by the Child Health Corporation of America (CHCA, Shawnee Mission, KS), a business alliance of 43 children' s hospitals with extensive experience in overseeing collaborative quality improvement. [12][13][14] CHCA subsequently merged with the National Association of Children' s Hospitals and Related Institutions to form the Children' s Hospital Association. The project was open to all CHCA-affiliated hospitals as of May 1, 2010.…”

Section: The Collaborativementioning

confidence: 99%

Decreasing Handoff-Related Care Failures in Children’s Hospitals

Bigham¹,

Logsdon

Manicone³

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Patient handoffs in health care require transfer of information, responsibility, and authority between providers. Suboptimal patient handoffs pose a serious safety risk. Studies demonstrating the impact of improved patient handoffs on care failures are lacking. The primary objective of this study was to evaluate the effect of a multihospital collaborative designed to decrease handoff-related care failures.METHODS: Twenty-three children' s hospitals participated in a quality improvement collaborative aimed at reducing handoff-related care failures. The improvement was guided by evidence-based recommendations regarding handoff intent and content, standardized handoff tools/methods, and clear transition of responsibility. Hospitals tailored handoff elements to locally important handoff types. Handoff-related care failures were compared between baseline and 3 intervention periods. Secondary outcomes measured compliance to specific change package elements and balancing measure of staff satisfaction. RESULTS:Twenty-three children' s hospitals evaluated 7864 handoffs over the 12-month study period. Handoff-related care failures decreased from baseline (25.8%) to the final intervention period (7.9%) (P , .05). Significant improvement was observed in every handoff type studied. Compliance to change package elements improved (achieving a common understanding about the patient from 86% to 96% [P , .05]; clear transition of responsibility from 92% to 96% [P , .05]; and minimized interruptions and distractions from 84% to 90% [P , .05]) as did overall satisfaction with the handoff (from 55% to 70% [P , .05]).CONCLUSIONS: Implementation of a standardized evidence-based handoff process across 23 children' s hospitals resulted in a significant decrease in handoff-related care failures, observed over all handoff types. Compliance to critical components of the handoff process improved, as did provider satisfaction. Pediatrics 2014;134: e572-e579 AUTHORS:

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“…1 Although numerous studies have examined the clinical impacts of pediatric [2][3][4][5][6][7][8][9][10] and adult 11,12 METs, no studies have evaluated their financial costs and benefits.…”

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confidence: 99%

Cost-Benefit Analysis of a Medical Emergency Team in a Children’s Hospital

Bonafide

Localio

Song³

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Numerous studies have demonstrated clinical benefits of medical emergency team (MET) implementation, including reductions in mortality, cardiac arrests, and critical deterioration events. No studies have evaluated the financial costs and benefits of METs. WHAT THIS STUDY ADDS:The costs of operating an MET can plausibly be recouped with a modest reduction in critical deterioration events. Hospitals reimbursed with bundled payments could see real financial savings by reducing critical deterioration events with a MET. abstract OBJECTIVES: Medical emergency teams (METs) can reduce adverse events in hospitalized children. We aimed to model the financial costs and benefits of operating an MET and determine the annual reduction in critical deterioration (CD) events required to offset MET costs. METHODS:We performed a single-center cohort study between July 1, 2007 and March 31, 2012 to determine the cost of CD events (unplanned transfers to the ICU with mechanical ventilation or vasopressors in the 12 hours after transfer) as compared with transfers to the ICU without CD. We then performed a cost-benefit analysis evaluating varying MET compositions and staffing models (freestanding or concurrent responsibilities) on the annual reduction in CD events needed to offset MET costs. RESULTS:Patients who had CD cost $99 773 (95% confidence interval, $69 431 to $130 116; P , .001) more during their post-event hospital stay than transfers to the ICU that did not meet CD criteria. Annual MET operating costs ranged from $287 145 for a nurse and respiratory therapist team with concurrent responsibilities to $2 358 112 for a nurse, respiratory therapist, and ICU attending physician freestanding team. In base-case analysis, a nurse, respiratory therapist, and ICU fellow team with concurrent responsibilities cost $350 698 per year, equivalent to a reduction of 3.5 CD events.CONCLUSIONS: CD is expensive. The costs of operating a MET can plausibly be recouped with a modest reduction in CD events. Hospitals reimbursed with bundled payments could achieve real financial savings by reducing CD with an MET. Pediatrics 2014;134:235-241

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A Multicenter Collaborative Approach to Reducing Pediatric Codes Outside the ICU

Abstract: A complex process, such as patient deterioration, requires sufficient time and effort to achieve improved outcomes and create a deeply embedded culture of patient safety. The collaborative model can accelerate improvements achieved by individual institutions.

Cited by 46 publications

References 21 publications

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

Decreasing Handoff-Related Care Failures in Children’s Hospitals

Cost-Benefit Analysis of a Medical Emergency Team in a Children’s Hospital

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