title: Cost-benefit analysis of a medical emergency team in a children's hospital.
abstract: OBJECTIVE
  Medical emergency teams (METs) can reduce adverse events in hospitalized children. We aimed to model the financial costs and benefits of operating an MET and determine the annual reduction in critical deterioration (CD) events required to offset MET costs.
  
  
  METHODS
  We performed a single-center cohort study between July 1, 2007 and March 31, 2012 to determine the cost of CD events (unplanned transfers to the ICU with mechanical ventilation or vasopressors in the 12 hours after transfer) as compared with transfers to the ICU without CD. We then performed a cost-benefit analysis evaluating varying MET compositions and staffing models (freestanding or concurrent responsibilities) on the annual reduction in CD events needed to offset MET costs.
  
  
  RESULTS
  Patients who had CD cost $99,773 (95% confidence interval, $69,431 to $130,116; P < .001) more during their post-event hospital stay than transfers to the ICU that did not meet CD criteria. Annual MET operating costs ranged from $287,145 for a nurse and respiratory therapist team with concurrent responsibilities to $2,358,112 for a nurse, respiratory therapist, and ICU attending physician freestanding team. In base-case analysis, a nurse, respiratory therapist, and ICU fellow team with concurrent responsibilities cost $350,698 per year, equivalent to a reduction of 3.5 CD events.
  
  
  CONCLUSIONS
  CD is expensive. The costs of operating a MET can plausibly be recouped with a modest reduction in CD events. Hospitals reimbursed with bundled payments could achieve real financial savings by reducing CD with an MET.
authors: Division of General Pediatrics,Departments of Pediatrics,Center for Pediatric Clinical Effectiveness,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and bonafide@email.chop.edu.
authors: Christopher P
authors: CP
authors: Bonafide
authors: Biostatistics and Epidemiology, and.
authors: A Russell
authors: AR
authors: Localio
authors: Center for Pediatric Clinical Effectiveness.
authors: Lihai
authors: L
authors: Song
authors: Departments of Nursing.
authors: Kathryn E
authors: KE
authors: Roberts
authors: Anesthesiology and Critical Care Medicine, andAnesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors: Vinay M
authors: VM
authors: Nadkarni
authors: Anesthesiology and Critical Care Medicine, andAnesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors: Margaret
authors: M
authors: Priestley
authors: Division of General Pediatrics.
authors: Christine W
authors: CW
authors: Paine
authors: Division of General Pediatrics.
authors: Miriam
authors: M
authors: Zander
authors: Finance, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors: Meaghan
authors: M
authors: Lutts
authors: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Patrick W
authors: PW
authors: Brady
authors: Division of General Pediatrics,Departments of Pediatrics,Center for Pediatric Clinical Effectiveness,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors: Ron
authors: R
authors: Keren
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016638:Critical Illness / Q000191:economics / Q000628:therapy; D005260:Female; D017721:Hospital Costs; D057209:Hospital Rapid Response Team / Q000191:economics*; D006776:Hospitals, Pediatric / Q000191:economics*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D010360:Patient Transfer; D012121:Respiration, Artificial / Q000191:economics
keywords: Patient Protection and Affordable Care Act; cost-benefit analysis; health care financing; hospital rapid response team; intensive care units