Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit

被引:205
作者
Brilli, Richard J. [1 ]
Gibson, Rosemary
Luria, Joseph W.
Wheeler, T. Arthur
Shaw, Julie
Linam, Matt
Kheir, John
McLain, Patricia
Lingsch, Tammy
Hall-Haering, Amy
McBride, Mary
机构
[1] Cincinnati Coll Med, Pediat Intens Care Unit, Cincinnati, OH 45221 USA
[2] Cincinnati Coll Med, Div Crit Care Med, Cincinnati, OH USA
[3] Cincinnati Childrens Hosp & Med Ctr, Ctr Heart, Cincinnati, OH USA
[4] Cincinnati Childrens Hosp & Med Ctr, Patient Serv, Cincinnati, OH USA
关键词
cardiopulmonary arrest; respiratory arrest; pediatrics; children; rapid response system; medical emergency team;
D O I
10.1097/01.PCC.0000262947.72442.EA
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: We implemented a medical emergency team (MET) in our free-standing children's hospital. The specific aim was to reduce the rate of codes (respiratory and cardiopulmonary arrests) outside the intensive care units by 50% for > 6 months following MET implementation. Design: Retrospective chart review and program implementation. Setting. A children's hospital. Patients. None. Interventions. The records of patients who required cardiorespiratory resuscitation outside the critical care areas were reviewed before MET implementation to determine activation criteria for the MET. Codes were prospectively defined as respiratory arrests or cardiopulmonary arrests. MET-preventable codes were prospectively defined. The incidence of codes before and after MET implementation was recorded. Measurements and Main Results: Twenty-five codes occurred during the pre-MET baseline compared with six following MET implementation. The code rate (respiratory arrests + cardiopulmonary arrests) post-MET was 0.11 per 1,000 patient days compared with baseline of 0.27 (risk ratio, 0.42; 95% confidence interval, 0-0.89; p =.03). The code rate per 1,000 admissions decreased from 1.54 (baseline) to 0.62 (post-MET) (risk ratio, 0.41; 95% confidence interval, 0-0.86; p =.02). For MET-preventable codes, the code rate post-MET was 0.04 per 1,000 patient days compared with a baseline of 0.14 (risk ratio, 0.27; 95% confidence interval, 0-0.94; p =.04). There was no difference in the incidence of cardiopulmonary arrests before and after MET. For codes outside the intensive care unit, the pre-MET mortality rate was 0.12 per 1,000 days compared with 0.06 post-MET (risk ratio, 0.48; 95% confidence interval, 0-1.4, p =.13). The overall mortality rate for outside the intensive care unit codes was 42% (15 of 36 patients). Conclusions: Implementation of a MET is associated with a reduction in the risk of respiratory and cardiopulmonary arrest outside of critical care areas in a large tertiary children's hospital.
引用
收藏
页码:236 / 246
页数:11
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