Reduction in Hospital Mortality Over Time in a Hospital Without a Pediatric Medical Emergency Team

Joffe, Ari R.; Anton, Natalie; Burkholder, Shauna C.

doi:10.1001/archpediatrics.2011.47

Cited by 55 publications

(47 citation statements)

References 19 publications

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“…The data has been largely observational and was from before-and-after studies, which may have unaccounted or confounding variables. (13)(14)(15)(16) Joffe et al (17) demonstrated the potential for risk of bias or confounding variables by comparing the mortality rate at their institution, which did not initiate or organise a MET/RRT, with that of fi ve published studies (all reviewed by ILCOR). The reduction in mortality at Joffe et al's institution over the same time period was similar to the published results, illustrating the problems of confounding variables and contemporaneous trends.…”

Section: Medical Emergency Team/rapid Response Teammentioning

confidence: 99%

Singapore Paediatric Resuscitation Guidelines 2016

Ong

Chan

et al. 2017

smedj

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Section: Medical Emergency Team/rapid Response Teammentioning

confidence: 99%

Singapore Paediatric Resuscitation Guidelines 2016

Ong

Chan

et al. 2017

smedj

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“…Joffe et al 26 demonstrated the potential for risk of bias or confounding variables by comparing the mortality rate at their institution, which did not initiate or organize a MET/ RRT, with 5 published studies (all reviewed here). The reduction in mortality at their institution over the same time period was similar to the published results, illustrating the problems of confounding variables and contemporaneous trends.…”

Section: Knowledge Gapsmentioning

confidence: 99%

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

Caen¹,

Maconochie²,

Aickin³

et al. 2015

Pediatrics

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“…Also, a challenge to evaluating RRTs is the worry that secular trends and other safety interventions may overstate the effect of RRTs. A study at a Canadian hospital without an RRT showed similar declines in mortality as observed in hospitals with RRTs [77]. Still, the level 1 evidence adds weight to the accumulating level 2-5 evidence and is sufficient to support implementation [10, 68, 78•, 79].…”

Section: Evidence For Rrtmentioning

confidence: 99%

Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children

Levin

Brady

Duncan

et al. 2015

Curr Treat Options Peds

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Opinion statementRapid response systems (RRSs) aim to identify deteriorating hospitalized patients outside of the intensive care unit, respond quickly, and escalate to a higher level of care if needed. Despite a decade of evaluation, how to best design an RRS is still under study and debate. When considering your RRS, our recommendation is to start with the outcomes: what improvements in patient care are most needed in your environment? These may include reducing cardiac arrest or mortality, reducing critical deterioration, reducing length of stay in intensive care, or avoiding all preventable patient harm. Then, select a strategy for identification of at-risk patients, a response team structure that meets your institution's needs, and a quality improvement and governance structure to ensure you monitor process and outcome variables. The identification limb detects at-risk patients. For this, we recommend an aggregate pediatric early warning score (EWS), clear guidance regarding monitoring type and frequency, flagging of diagnostic risk factors, and a mandatory escalation system that uses the expertise of nurses, patients, and families and works around barriers to enhance response team activation. The structure and function of the response limb are also dependent upon the needs of the institution. We recommend a multidisciplinary team with the skills and resources to assess and manage emergencies. Proactive identification through a rover team or scheduled safety huddles may help with earlier identification of at risk patients. The quality improvement and governance structure should be designed around the desired outcomes. Regular monitoring and review of successes, near misses, and failures are vital for the system to improve outcomes.

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Reduction in Hospital Mortality Over Time in a Hospital Without a Pediatric Medical Emergency Team

Cited by 55 publications

References 19 publications

Singapore Paediatric Resuscitation Guidelines 2016

Singapore Paediatric Resuscitation Guidelines 2016

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

Pediatric Rapid Response Systems: Identification and Treatment of Deteriorating Children

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