Development of a Pragmatic Measure for Evaluating and Optimizing Rapid Response Systems

Bonafide, Christopher P.; Roberts, Kathryn E.; Priestley, Margaret A.; Tibbetts, Kathleen M.; Huang, Emily J.; Nadkarni, Vinay; Keren, Ron

doi:10.1542/peds.2011-2784

Cited by 84 publications

(69 citation statements)

References 16 publications

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“…We classified events requiring any of these interventions in the first 12 hours after ICU transfer as CD. 10,13 Financial Data Source…”

Section: Data Collectionmentioning

confidence: 99%

“…Recently, pre-arrest proximate outcomes have been described as targets for pediatric MET evaluation. 10,13,14 One of these measures, the critical deterioration (CD) metric, was developed 13 and validated 10 by our research team. Included in this measure are rare catastrophic outcomes (arrests and deaths), as well as pre-arrest events that required ICU transfer and life-sustaining interventions.…”

mentioning

confidence: 99%

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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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“…We classified events requiring any of these interventions in the first 12 hours after ICU transfer as CD. 10,13 Financial Data Source…”

Section: Data Collectionmentioning

confidence: 99%

mentioning

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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“…However, pooled data and newer metrics suggest that modified pediatric early warning score (MPEWS) and RRT can be effective at recognition and response to severe clinical deterioration. 6,7,8 Because early warning scores have been effective in identification of high-risk inpatients, there has been interest in applying these scores to patients in the emergency department (ED), since a subset of patients initially admitted to the inpatient ward rapidly deteriorate and require transfer to the ICU. A case-control study in the UK evaluated the ability of the pediatric advanced warning system (PAWS) to distinguish ED patients requiring ICU admission from patients requiring inpatient pediatric ward admission.…”

Section: Introductionmentioning

confidence: 99%

Identifying High-Risk Children in the Emergency Department

Nielsen

Migita

Batra

et al. 2016

J Intensive Care Med

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Identifying high risk children in the emergency department Katie R. Nielsen Chair of the Supervisory Committee:Noel S. Weiss, MD, DrPH EpidemiologyObjectives: Early warning scores reduce the occurrence of in-hospital cardiac arrest by identifying high-risk hospitalized patients prior to clinical deterioration. However, the ability of early warning scores to identify high-risk pediatric patients in the emergency department (ED)has not been evaluated. We aimed to determine the association between the modified pediatric early warning score (MPEWS) in the ED and clinical deterioration that necessitated subsequent inpatient ward-to-pediatric intensive care unit (PICU) transfer within 24 hours of admission.Methods: This is a case-control study of 597 pediatric patients admitted from the ED to the inpatient ward at Seattle Children's Hospital between July 1, 2010 and December 31, 2011.Cases were admitted to the inpatient ward and transferred to the PICU within 24 hours, whereas controls remained hospitalized on the inpatient ward at 24 hours. The association between MPEWS in the ED and ward-to-PICU transfer was determined by chi square analysis.Results: There were no differences in demographic characteristics between cases and controls.Children with an MPEWS of 7 or greater in the ED were relatively more likely to be transferred to the PICU within 24 hours (OR 8.36, 95% CI 2.98, 22.08). However, an MPEWS threshold of 7 yielded a sensitivity of only 18.0% and a specificity of 97.4%.Conclusions: Elevated MPEWS in the ED is associated with increased risk of ward-to-PICU transfer within 24 hours of admission; however, an MPEWS of 7 or higher is not sufficient to identify more than a small proportion of children with subsequent clinical deterioration.

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“…(16) Studies using a more valid and proximate outcome metric, such as Bonafi de et al's critical decision event, (18) may be better able to answer the question of whether METs/RRTs are truly feasible and effective, before strengthening the case for their implementation in the paediatric inpatient setting. Quality improvement methodology could be used to regulate the impact of a series of changes, which include educational processes, documentation review with feedback systems, and modifi cation of other factors that are thought to improve the delivery of care.…”

Section: Medical Emergency Team/rapid Response Teammentioning

confidence: 99%