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CC BY-NC-ND 4.0 · J Pediatr Intensive Care
DOI: 10.1055/s-0042-1744297
Original Article

Relationship between Time of Day of Medical Emergency Team Activations and Outcomes of Hospitalized Pediatric Patients

Joshua Feder
1   Department of Pediatrics, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
,
Christa Ramsay
2   Department of Respiratory Therapy, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
,
Anne Tsampalieros
3   Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
,
Nick Barrowman
3   Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
,
Kara Richardson
2   Department of Respiratory Therapy, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
,
Sara Rizakos
4   MD Candidate, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
,
Julia Sweet
4   MD Candidate, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
,
James Dayre McNally
2   Department of Respiratory Therapy, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
5   Division of Critical Care, Children's Hospital of Eastern Ontario, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
,
Anna-Theresa Lobos
5   Division of Critical Care, Children's Hospital of Eastern Ontario, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
› Author Affiliations Funding This article received its funding from PSI Foundation and CHEORI Resident Research Grant
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Abstract

This study was conducted to investigate whether outcomes of medical emergency team (MET) activations differ by time of day of in-hospitalized pediatric patients. This is a retrospective cohort study. Data were extracted from the charts of 846 patients (with one or more MET activations) over a 5-year period. It was conducted at Children's Hospital of Eastern Ontario, a tertiary pediatric hospital in Ottawa, Canada, affiliated with University of Ottawa. Patients included children <18 years, admitted to a pediatric ward, who experienced a MET activation between January 1, 2016 and December 31, 2020. We excluded patients reviewed by the MET during a routine follow-up, planned pediatric intensive care unit (PICU) admissions from the ward, and MET activation in out-patient settings, post-anesthesia care unit, and neonatal intensive care unit. There was no intervention. A total of 1,230 MET encounters were included as part of the final analysis. Daytime (08:00–15:59) MET activation was associated with increased PICU admission (25.3%, p = 0.04). There was some evidence of a higher proportion of critical deterioration events (CDEs) during daytime MET activation; however, this did not reach statistical significance (24%, p = 0.09). The highest MET dosage occurred during the evening hours, 16:00 to 23:59 (15/1,000 admissions), and it was lowest overnight, 00:00 to 07:59 (8.8/1,000 admissions, p < 0.001). This period of lowest MET dosage immediately preceded the highest likelihood of PICU admission (08:00, 37.5%) and CDE (09:00, 30.2%). Following the period of lowest MET activity overnight, MET activations during early daytime hours were associated with the highest likelihood of unplanned PICU admission and CDEs. This work identifies potential high-risk periods for undetected critical deterioration and targets for future quality improvement.

Keywords

pediatric - critical care - medical emergency team - rapid response system - critical deterioration events - PICU admission

Supplementary Material



Publication History

Received: 29 November 2021

Accepted: 07 February 2022

Article published online:
08 March 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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