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

Abstract

This study was conducted to investigate whether outcomes of medical emergency team (MET) activations differ by time of day of hospitalized pediatric patients. This is a retrospective cohort study conduct at a tertiary pediatric hospital. Data were extracted from the charts of 846 patients (with one or more MET activations) over a 5-year period. Also can remove hospital names and affiliated institution from the body of the text as readers can find this information in the author list. 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: PICU admission; critical care; critical deterioration events; medical emergency team; pediatric; rapid response system.

Fig. 1

( A ) Percentage of medical emergency team (MET) calls by time of encounter and ( B ) dosage by encounter time interval. (A) The vertical axis on the left is the percent of MET call by time of encounter and the vertical axis on the right is the absolute number of calls by time of encounter. The gray shading illustrates the 95% confidence interval (CI) bands around each proportion. Please note that for each time listed, it implies that hour (i.e., 7:00 = 07:00–07:59). (B) There were 1,229 encounters and 33,376 admissions overall. The overall MET dosage is 36.8 per 1,000 admissions (95% CI: 34.8–38.9). MET dosage by 8-hour intervals. There were 294 encounters between 00:00 and 08:00 and the MET dosage is 8.8 per 1,000 admissions (95% CI: 7.8–9.9). There were 434 encounters between 08:00 and 16:00 and the MET dosage is 13.0 per 1,000 admissions (95% CI: 11.8–14.3). There were 501 encounters between 16:00 and 00:00 and the MET dosage is 15.0 per 1,000 admissions (95% CI: 13.7–16.4).

Fig. 2

Percentage of MET calls leading to ( A ) PICU admission and ( B ) critical deterioration event. The vertical axis on the left is the percent of MET calls by time of encounter that had a (A) PICU admission or (B) a critical deterioration event within 12 hours from the initial encounter. The gray shading represents 95% confidence interval bands around each proportion of calls with the outcome. Panel A: The lowest proportion of PICU admissions was between 7 and 759 a.m., n  = 3 (11.5%), and the highest proportion between 8 and 859 a.m., n  = 20 (37.5%). Panel B: The lowest proportion of critical deterioration events was between 0 and 0:59 a.m., n  = 4 (10.9%), and the highest proportion between 9 and 959 a.m., n  = 18 (32.1%). PICU, pediatric intensive care unit.