title: Transition from a traditional code team to a medical emergency team and categorization of cardiopulmonary arrests in a children's center.
abstract: OBJECTIVE
  To study the effect of an intervention on prevention of respiratory arrest and cardiopulmonary arrest (CPA) and to characterize ward CPAs by preceding signs and symptoms and initial cardiac rhythm.
  
  
  METHODS
  A before-and-after interventional trial (12 months preintervention and 12 months postintervention).
  
  
  METHODS
  A tertiary care, academic children's hospital.
  
  
  METHODS
  Admitted patients who subsequently had either the code team or pediatric medical emergency team (PMET) called or who had a respiratory arrest or CPA on the wards. Intervention Transition from a traditional code team to a PMET that responds to clinically deteriorating children in noncritical care areas.
  
  
  METHODS
  Combined rate of respiratory arrests and CPAs, rate of CPAs, and rate of respiratory arrests on the wards and agreement between independent reviewers on categorization of CPAs.
  
  
  RESULTS
  There was no change in the rate of CPAs on the wards. However, there was a 73% decrease in the incidence of respiratory arrests (0.23 respiratory arrests/1000 patient-days pre-PMET vs 0.06 post-PMET, P = .03). There was 100% agreement between reviewers on categorization of CPAs.
  
  
  CONCLUSIONS
  Transition to a PMET was not associated with a change in CPAs but was associated with a significant decrease in the incidence of ward respiratory arrests. We also describe children who may have benefited from the PMET but whose data were not captured by current outcome measures. Finally, we present a new method for categorization of ward CPAs based on preceding signs and symptoms and initial cardiac rhythm.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, 600 N Wolfe St, Blalock 904, Baltimore, MD 21287, USA. ehunt@jhmi.edu
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hunt
authors.forename: Karen P
authors.initials: KP
authors.lastname: Zimmer
authors.forename: Michael L
authors.initials: ML
authors.lastname: Rinke
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Shilkofski
authors.forename: Carol
authors.initials: C
authors.lastname: Matlin
authors.forename: Catherine
authors.initials: C
authors.lastname: Garger
authors.forename: Conan
authors.initials: C
authors.lastname: Dickson
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
mesh_terms: D016887:Cardiopulmonary Resuscitation; D002648:Child; D065187:Controlled Before-After Studies; D004554:Electric Countershock / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy*; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000458:organization & administration*; D016019:Survival Analysis