title: Regular in-situ simulation training of paediatric Medical Emergency Team leads to sustained improvements in hospital response to deteriorating patients, improved outcomes in intensive care and financial savings.
abstract: The introduction of a paediatric Medical Emergency Team (pMET) was accompanied by weekly in-situ simulation team training. Key ward staff participated in team training, focusing on recognition of the deteriorating child, teamwork and early involvement of senior staff. Following an earlier study [1], this investigation aimed to evaluate the long-term impact of ongoing regular team training on hospital response to deteriorating ward patients, patient outcome and financial implications.
  
  
  
  Prospective cohort study of all deteriorating in-patients in a tertiary paediatric hospital requiring admission to paediatric intensive care (PICU) the year before, 1year after and 3 years after the introduction of pMET and team training.
  
  
  
  Deteriorating patients were recognised more promptly (before/1year after/3years after pMET; median time 4/1.5/0.5h, p<0.001), more often reviewed by consultants (45%/76%/81%, p<0.001) and more rapidly escalated to PICU (median time 10.5/5/3.5h, p=0.02). There was a significant reduction in associated PICU admissions (56/51/32, p=0.02) and PICU bed days (527/336/193, p<0.001). The total annual cost of training (£74,250) was more than offset by savings from reduced PICU bed days (£801,600 per annum). Introduction of pMET coincided with significantly reduced hospital mortality (p<0.001).
  
  
  
  These results indicate that lessons learnt by ward staff during team training led to sustained improvements in the hospital response to critically deteriorating in-patients, significantly improved patient outcomes and substantial savings. Integration of regular in-situ simulation training of medical emergency teams, including key ward staff, in routine clinical care has potential application in all acute specialties.
authors.affiliation: Royal Hospital for Sick Children, Edinburgh, 1 Sciennes Road, EH9 1LF, United Kingdom; University of Edinburgh, Child Life and Health, Edinburgh, 20 Sylvan Place, EH9 1UW, United Kingdom. Electronic address: ulf.theilen@luht.scot.nhs.uk.
authors.forename: Ulf
authors.initials: U
authors.lastname: Theilen
authors.affiliation: Royal Hospital for Sick Children, Edinburgh, 1 Sciennes Road, EH9 1LF, United Kingdom.
authors.forename: Laura
authors.initials: L
authors.lastname: Fraser
authors.affiliation: University of Edinburgh, Child Life and Health, Edinburgh, 20 Sylvan Place, EH9 1UW, United Kingdom.
authors.forename: Patricia
authors.initials: P
authors.lastname: Jones
authors.affiliation: Royal Hospital for Sick Children, Edinburgh, 1 Sciennes Road, EH9 1LF, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Leonard
authors.affiliation: Royal Hospital for Sick Children, Edinburgh, 1 Sciennes Road, EH9 1LF, United Kingdom.
authors.forename: Dave
authors.initials: D
authors.lastname: Simpson
mesh_terms: D000075902:Clinical Deterioration; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000191:economics / Q000458:organization & administration*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000191:economics / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data; D016730:Program Development; D011446:Prospective Studies; D000066908:Simulation Training / Q000191:economics / Q000379:methods*; D013997:Time Factors
keywords: Human factors; In-situ simulation team training; Inclusion of ward staff; Intensive care outcomes; Mecial Emergency Team; Response to deteriorating patients; Return of investment