title: Patient characteristics and disposition after pediatric medical emergency team (MET) activation: disposition depends on who activates the team.
abstract: OBJECTIVE
  This study focused on health care staff (HCS) responsible for activating the medical emergency team (MET) at a pediatric tertiary hospital using a well-established rapid response system. Our goals were to report the patient characteristics, MET interventions, and disposition by activating HCS.
  
  
  METHODS
  This is a retrospective cohort study of pediatric patients who received MET activation at the Children's Hospital of Eastern Ontario in Ottawa, Canada. Data were obtained from a prospectively maintained rapid response system database. The primary outcome was PICU admission, with the number and type of interventions performed as secondary outcomes.
  
  
  RESULTS
  The most common MET activators were physicians (410, 53.3%) with nurses generating a comparable number (367, 47.7%). Significant differences in PICU admission rates were observed between activator groups, with physicians having statistically higher PICU admission rates when compared with nurses (25.2% vs 15.0%, P = .001). Compared with physicians, nursing-led activations on surgical patients had significantly lower odds of PICU admission relative to medical patients (odds ratio 0.19 vs 0.67; P = .03). No significant difference was observed in the type or number of interventions between any subgroup based on patient (surgery vs medical) or activator type.
  
  
  CONCLUSIONS
  This study suggests that when nurses activate MET, patients are less likely to be transferred to the PICU despite receiving similar type and number of interventions. Our study results may help direct education initiatives aimed at enhancing the effectiveness of the afferent limb through informing specific HCS as to the importance of their role in using the MET.
authors.affiliation: Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada.
authors.forename: Anna-Theresa
authors.initials: AT
authors.lastname: Lobos
authors.forename: Rachel
authors.initials: R
authors.lastname: Fernandes
authors.forename: Tim
authors.initials: T
authors.lastname: Ramsay
authors.forename: James Dayre
authors.initials: JD
authors.lastname: McNally
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data*; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D033183:Interdisciplinary Communication; D009726:Nurses / Q000706:statistics & numerical data; D009864:Ontario; D010372:Pediatrics / Q000458:organization & administration / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: critical care; medical emergency team; multidisciplinary care