Association of pediatric medical emergency teams with hospital mortality

Shelby Kutty, Philip G. Jones, Quentin Karels, Navya Joseph, John A. Spertus, Paul S. Chan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: Implementation of medical emergency teams has been identifed as a potential strategy to reduce hospital deaths, because 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 preimplementation mortality trends. METHODS: Within the Pediatric Health Information System 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 preimplementation trends. RESULTS: Across 38 pediatric hospitals, mean annual hospital admission volume was 15 854 (range, 6684-33 024), and there were a total of 1 659 059 hospitalizations preimplementation and 4 392 392 hospitalizations postimplementation. Before medical emergency team implementation, hospital mortality decreased by 6.0% annually (odds ratio [OR], 0.94; 95% confdence interval [CI], 0.92-0.96) across all hospitals. After medical emergency team implementation, hospital mortality continued to decrease by 6% annually (OR, 0.94; 95% CI, 0.93-0.95), with no deepening of the mortality slope (ie, not lower OR) in comparison with the preimplementation trend, for the overall cohort (P=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 preimplementation trends) and actual mortality rates (hospital mean of 6.48 deaths per 1000 admissions; P=0.57). CONCLUSIONS: Implementation of medical emergency teams in a large sample of pediatric hospitals in the United States was not associated with a reduction in hospital mortality beyond existing preimplementation trends.

Original languageEnglish (US)
Pages (from-to)38-46
Number of pages9
JournalCirculation
Volume137
Issue number1
DOIs
StatePublished - Jan 2018

Fingerprint

Hospital Mortality
Emergencies
Pediatrics
Pediatric Hospitals
Mortality
Odds Ratio
Hospitalization
Health Information Systems
Heart Arrest

Keywords

  • Emergency medicine
  • Heart arrest
  • Hospital mortality
  • Hospital rapid response team
  • Hospitals, pediatric

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Kutty, S., Jones, P. G., Karels, Q., Joseph, N., Spertus, J. A., & Chan, P. S. (2018). Association of pediatric medical emergency teams with hospital mortality. Circulation, 137(1), 38-46. https://doi.org/10.1161/CIRCULATIONAHA.117.029535

Association of pediatric medical emergency teams with hospital mortality. / Kutty, Shelby; Jones, Philip G.; Karels, Quentin; Joseph, Navya; Spertus, John A.; Chan, Paul S.

In: Circulation, Vol. 137, No. 1, 01.2018, p. 38-46.

Research output: Contribution to journalArticle

Kutty, S, Jones, PG, Karels, Q, Joseph, N, Spertus, JA & Chan, PS 2018, 'Association of pediatric medical emergency teams with hospital mortality', Circulation, vol. 137, no. 1, pp. 38-46. https://doi.org/10.1161/CIRCULATIONAHA.117.029535
Kutty, Shelby ; Jones, Philip G. ; Karels, Quentin ; Joseph, Navya ; Spertus, John A. ; Chan, Paul S. / Association of pediatric medical emergency teams with hospital mortality. In: Circulation. 2018 ; Vol. 137, No. 1. pp. 38-46.
@article{17fd4da525524682912b0a50d2cf4edb,
title = "Association of pediatric medical emergency teams with hospital mortality",
abstract = "BACKGROUND: Implementation of medical emergency teams has been identifed as a potential strategy to reduce hospital deaths, because 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 preimplementation mortality trends. METHODS: Within the Pediatric Health Information System 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 preimplementation trends. RESULTS: Across 38 pediatric hospitals, mean annual hospital admission volume was 15 854 (range, 6684-33 024), and there were a total of 1 659 059 hospitalizations preimplementation and 4 392 392 hospitalizations postimplementation. Before medical emergency team implementation, hospital mortality decreased by 6.0{\%} annually (odds ratio [OR], 0.94; 95{\%} confdence interval [CI], 0.92-0.96) across all hospitals. After medical emergency team implementation, hospital mortality continued to decrease by 6{\%} annually (OR, 0.94; 95{\%} CI, 0.93-0.95), with no deepening of the mortality slope (ie, not lower OR) in comparison with the preimplementation trend, for the overall cohort (P=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 preimplementation trends) and actual mortality rates (hospital mean of 6.48 deaths per 1000 admissions; P=0.57). CONCLUSIONS: Implementation of medical emergency teams in a large sample of pediatric hospitals in the United States was not associated with a reduction in hospital mortality beyond existing preimplementation trends.",
keywords = "Emergency medicine, Heart arrest, Hospital mortality, Hospital rapid response team, Hospitals, pediatric",
author = "Shelby Kutty and Jones, {Philip G.} and Quentin Karels and Navya Joseph and Spertus, {John A.} and Chan, {Paul S.}",
year = "2018",
month = "1",
doi = "10.1161/CIRCULATIONAHA.117.029535",
language = "English (US)",
volume = "137",
pages = "38--46",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Association of pediatric medical emergency teams with hospital mortality

AU - Kutty, Shelby

AU - Jones, Philip G.

AU - Karels, Quentin

AU - Joseph, Navya

AU - Spertus, John A.

AU - Chan, Paul S.

PY - 2018/1

Y1 - 2018/1

N2 - BACKGROUND: Implementation of medical emergency teams has been identifed as a potential strategy to reduce hospital deaths, because 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 preimplementation mortality trends. METHODS: Within the Pediatric Health Information System 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 preimplementation trends. RESULTS: Across 38 pediatric hospitals, mean annual hospital admission volume was 15 854 (range, 6684-33 024), and there were a total of 1 659 059 hospitalizations preimplementation and 4 392 392 hospitalizations postimplementation. Before medical emergency team implementation, hospital mortality decreased by 6.0% annually (odds ratio [OR], 0.94; 95% confdence interval [CI], 0.92-0.96) across all hospitals. After medical emergency team implementation, hospital mortality continued to decrease by 6% annually (OR, 0.94; 95% CI, 0.93-0.95), with no deepening of the mortality slope (ie, not lower OR) in comparison with the preimplementation trend, for the overall cohort (P=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 preimplementation trends) and actual mortality rates (hospital mean of 6.48 deaths per 1000 admissions; P=0.57). CONCLUSIONS: Implementation of medical emergency teams in a large sample of pediatric hospitals in the United States was not associated with a reduction in hospital mortality beyond existing preimplementation trends.

AB - BACKGROUND: Implementation of medical emergency teams has been identifed as a potential strategy to reduce hospital deaths, because 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 preimplementation mortality trends. METHODS: Within the Pediatric Health Information System 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 preimplementation trends. RESULTS: Across 38 pediatric hospitals, mean annual hospital admission volume was 15 854 (range, 6684-33 024), and there were a total of 1 659 059 hospitalizations preimplementation and 4 392 392 hospitalizations postimplementation. Before medical emergency team implementation, hospital mortality decreased by 6.0% annually (odds ratio [OR], 0.94; 95% confdence interval [CI], 0.92-0.96) across all hospitals. After medical emergency team implementation, hospital mortality continued to decrease by 6% annually (OR, 0.94; 95% CI, 0.93-0.95), with no deepening of the mortality slope (ie, not lower OR) in comparison with the preimplementation trend, for the overall cohort (P=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 preimplementation trends) and actual mortality rates (hospital mean of 6.48 deaths per 1000 admissions; P=0.57). CONCLUSIONS: Implementation of medical emergency teams in a large sample of pediatric hospitals in the United States was not associated with a reduction in hospital mortality beyond existing preimplementation trends.

KW - Emergency medicine

KW - Heart arrest

KW - Hospital mortality

KW - Hospital rapid response team

KW - Hospitals, pediatric

UR - http://www.scopus.com/inward/record.url?scp=85047772134&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047772134&partnerID=8YFLogxK

U2 - 10.1161/CIRCULATIONAHA.117.029535

DO - 10.1161/CIRCULATIONAHA.117.029535

M3 - Article

C2 - 28978554

AN - SCOPUS:85047772134

VL - 137

SP - 38

EP - 46

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 1

ER -