Brady Patrick W, Zix Julie, Brilli Richard, Wheeler Derek S, Griffith Kristie, Giaccone Mary Jo, Dressman Kathy, Kotagal Uma, Muething Stephen, Tegtmeyer Ken
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.
Department of Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
BMJ Qual Saf. 2015 Mar;24(3):203-11. doi: 10.1136/bmjqs-2014-003001. Epub 2014 Dec 16.
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).
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.
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.
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.
家庭启动的医疗急救团队（MET）有潜力提高对临床病情恶化的及时识别，并减少可预防的不良事件。家庭启动MET的做法受到阻碍，原因是担心此类呼叫可能会大幅增加MET的工作量。我们旨在开发一种可靠的家庭启动MET流程，并评估其对MET呼叫率以及随后转入重症监护病房（ICU）的影响。
研究地点是我们的独立儿童医院。我们与家庭合作，为临床医生和家庭开发并测试一种教育干预措施、在每个病房张贴信息海报，并与处理MET呼叫的医院接线员重新设计流程。我们在统计过程控制图上跟踪家庭启动的MET呼叫计数这一主要结果。此外，我们确定了家庭启动与临床医生启动的MET之间的关联以及转入ICU的情况。最后，我们比较了家庭呼叫与2:1匹配的临床医生呼叫样本之间MET启动的原因。
在我们6年的研究期间，共有83次家庭启动的MET呼叫。家庭平均每月呼叫1.2次，占所有MET呼叫的2.9%。与临床医生启动MET呼叫的儿童相比，家庭启动MET呼叫的儿童转入ICU的情况较少（24%对60%，p<0.001）。与临床医生一样，家庭最常因担心临床病情恶化而呼叫MET。家庭还指出临床医生没有回应以及团队与家庭之间的轻视互动是呼叫的原因。
家庭启动MET的情况并不常见，对响应者也不是负担。这些呼叫识别出了临床病情恶化和沟通失败的情况。家庭启动的MET应在照顾儿童的医院进行测试和实施。
