title: Routine Medical Emergency Team Assessments of Patients Discharged From the PICU: Description of a Medical Emergency Team Follow-Up Program.
abstract: OBJECTIVE
  This study describes one follow-up program in the Ontario Rapid-Response System project consisting of routine medical emergency team visits of patients discharged from the PICU consisting of two planned visits within 48 hours following discharge. Study purpose was to describe interventions provided and the patient characteristics associated with medical emergency team utilization.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary Pediatric Hospital, Children's Hospital of Eastern Ontario, Ottawa, Canada.
  
  
  METHODS
  Discharged pediatric patients from PICU.
  
  
  METHODS
  Data over 41 months were obtained from a prospectively maintained rapid-response system database. Major medical emergency team support was defined as an early unplanned visit, intervention, or readmission during the follow-up period.
  
  
  RESULTS
  Interrupted time-series analysis comparing the 2 years preceding rapid-response system implementation with the subsequent 4 years demonstrated a statistically significant immediate change in PICU readmission rate (-5.5%, p = 0.0001). There were 1,805 patients followed after PICU discharge. During the 48-hour planned follow-up period, 4% of patients received an unplanned medical emergency team visit and 13% received an active intervention. Analysis of the first medical emergency team visit identified that 10% received major medical emergency team support. After the initial visit, 6% of patients received major medical emergency team support with predictive characteristics being an unplanned first visit (odds ratio, 3.7; 95% CI, 1.6-8.5) or an intervention during the first visit (odds ratio, 3.5; 95% CI, 2.1-5.8). Multiple diseased organs were associated with major medical emergency team support after the initial visit for recent surgical patients (odds ratio, 3.0 vs 1.2; p = 0.03).
  
  
  CONCLUSIONS
  Routine medical emergency team visits following PICU discharge reduced the risk of early readmission. Our results suggest that one in seven patients in the follow-up program receive major medical emergency team support. We suggest a follow-up program with at least one routine medical emergency team visit within the first 24 hours of discharge with a second planned visit reserved for complex postsurgical patients.
authors.affiliation: 1Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 2University of Ottawa, Ottawa, ON, Canada. 3Clinical Research Center, Boston Children's Hospital, Boston, MA. 4Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 5Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
authors.forename: Anna-Theresa
authors.initials: AT
authors.lastname: Lobos
authors.forename: Rachel
authors.initials: R
authors.lastname: Fernandes
authors.forename: Kathyrn
authors.initials: K
authors.lastname: Willams
authors.forename: Christa
authors.initials: C
authors.lastname: Ramsay
authors.forename: James Dayre
authors.initials: JD
authors.lastname: McNally
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys / 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*; D008297:Male; D009864:Ontario; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors