title: Developing and evaluating the success of a family activated medical emergency team: a quality improvement report.
abstract: BACKGROUND
  Family-activated medical emergency teams (MET) have the potential to improve the timely recognition of clinical deterioration and reduce preventable adverse events. Adoption of family-activated METs is hindered by concerns that the calls may substantially increase MET workload. We aimed to develop a reliable process for family activated METs and to evaluate its effect on MET call rate and subsequent transfer to the intensive care unit (ICU).
  
  
  METHODS
  The setting was our free-standing children's hospital. We partnered with families to develop and test an educational intervention for clinicians and families, an informational poster in each patient room and a redesigned process with hospital operators who handle MET calls. We tracked our primary outcome of count of family-activated MET calls on a statistical process control chart. Additionally, we determined the association between family-activated versus clinician-activated MET and transfer to the ICU. Finally, we compared the reason for MET activation between family calls and a 2:1 matched sample of clinician calls.
  
  
  RESULTS
  Over our 6-year study period, we had a total of 83 family-activated MET calls. Families made an average of 1.2 calls per month, which represented 2.9% of all MET calls. Children with family-activated METs were transferred to the ICU less commonly than those with clinician MET calls (24% vs 60%, p<0.001). Families, like clinicians, most commonly called MET for concerns of clinical deterioration. Families also identified lack of response from clinicians and a dismissive interaction between team and family as reasons.
  
  
  CONCLUSIONS
  Family MET activations were uncommon and not a burden on responders. These calls recognised clinical deterioration and communication failures. Family activated METs should be tested and implemented in hospitals that care for children.
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Brady
authors.affiliation: Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Zix
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Brilli
authors.affiliation: Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Derek S
authors.initials: DS
authors.lastname: Wheeler
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
authors.forename: Kristie
authors.initials: K
authors.lastname: Griffith
authors.affiliation: Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Giaccone
authors.affiliation: Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Dressman
authors.affiliation: Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Uma
authors.initials: U
authors.lastname: Kotagal
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Department of Pediatrics, James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Muething
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Tegtmeyer
mesh_terms: D003142:Communication; D004630:Emergencies; D005190:Family; D006266:Health Education; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006801:Humans; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration*
keywords: Healthcare quality improvement; Hospital medicine; Medical emergency team; Paediatrics; Patient safety