Association of Pediatric Medical Emergency Teams with Hospital Mortality
Background—Implementation of a medical emergency teams has been identified as a potential strategy to reduce hospital deaths, as these teams respond to patients with acute physiological decline in an effort to prevent in-hospital cardiac arrest. However, prior studies of the association between medical emergency teams and hospital mortality have been limited and typically have not accounted for pre-implementation mortality trends.
Methods—Within the Pediatric Health Information System (PHIS) for freestanding pediatric hospitals, annual risk-adjusted mortality rates were calculated for sites between 2000 and 2015. A random slopes interrupted time series analysis then examined whether implementation of a medical emergency team was associated with lower than expected mortality rates based on pre-implementation trends.
Results—Across 38 pediatric hospitals, mean annual hospital admission volume was 15,854 (range: 6,684-33,024), and there were a total of 1,659,059 hospitalizations pre-implementation and 4,392,392 hospitalizations post-implementation. Before medical emergency team implementation, hospital mortality decreased by 6.0% annually (odds ratio [OR] of 0.94 [95% CI: 0.92-0.96]) across all hospitals. After medical emergency team implementation, hospital mortality continued to decrease by 6% annually (OR of 0.94 [95% CI: 0.93-0.95]), with no deepening of the mortality slope (i.e., not lower odds ratio) as compared with the pre-implementation trend, for the overall cohort (P of 0.98) or when analyzed separately within each of the 38 study hospitals. Five years after medical emergency team implementation across study sites, there was no difference between predicted (hospital mean of 6.18 deaths per 1000 admissions based on pre-implementation trends) and actual mortality rates (hospital mean of 6.48 deaths per 1000 admissions; P of 0.57).
Conclusions—Implementation of medical emergency teams in a large sample of pediatric hospitals in the U.S was not associated with a reduction in hospital mortality beyond existing pre-implementation trends.
- Received May 16, 2017.
- Revision received September 11, 2017.
- Accepted September 15, 2017.