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

Abstract

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

An Update on Cardiopulmonary Resuscitation in Children

“…This amounts to 0.77 children receiving CPR per 1000 hospital admissions [6]. Due in part to the widespread implementation of rapid response systems in most children's hospitals [8][9][10] and the recognition of at-risk in-patients, >95% of CPR events in the USA occur in ICUs [11]. The prevalence of CPR among one cohort of academic children's hospitals was 1.4% from 2010 to 2013, compared with 1.8% reported in the 1990s [7].…”

Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support

“…This is apparent in that most studies demonstrated trends of improving cardiac arrest rate or mortality, although not to statistically significant levels. Use of a more proximate outcome metric, like a critical deterioration event, 25 might further support implementation of a MET/RRT in the pediatric inpatient setting.…”

What’s new with rapid response systems?

“…Otherwise, adverse events may occur in ICU patients while critical care staff are on RRT calls [13]. Importantly, cost savings associated with preventing unplanned ICU admissions may in itself justify the funding of a hospital-wide RRS [14].…”