title: Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit.
abstract: 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.
  
  
  METHODS
  Retrospective chart review and program implementation.
  
  
  METHODS
  A children's hospital.
  
  
  METHODS
  None.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Pediatric Intensive Care Unit, Cincinnati College of Medicine, Cincinnati, OH, USA. rich.brilli@cchmn.org
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Brilli
authors.forename: Rosemary
authors.initials: R
authors.lastname: Gibson
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Luria
authors.forename: T Arthur
authors.initials: TA
authors.lastname: Wheeler
authors.forename: Julie
authors.initials: J
authors.lastname: Shaw
authors.forename: Matt
authors.initials: M
authors.lastname: Linam
authors.forename: John
authors.initials: J
authors.lastname: Kheir
authors.forename: Patricia
authors.initials: P
authors.lastname: McLain
authors.forename: Tammy
authors.initials: T
authors.lastname: Lingsch
authors.forename: Amy
authors.initials: A
authors.lastname: Hall-Haering
authors.forename: Mary
authors.initials: M
authors.lastname: McBride
mesh_terms: D002648:Child; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006323:Heart Arrest / Q000517:prevention & control*; D006776:Hospitals, Pediatric; D006784:Hospitals, Teaching; D006801:Humans; D015278:Intensive Care Units, Pediatric; D012189:Retrospective Studies