Diurnal Variation in Medical Emergency Team Calls at a Tertiary Care Children's Hospital

Susan R Conway; Ken Tegtmeyer; Derek S Wheeler; Allison Loechtenfeldt; Erika L Stalets; Patrick W Brady

doi:10.1097/pq9.0000000000000341

Diurnal Variation in Medical Emergency Team Calls at a Tertiary Care Children's Hospital

Pediatr Qual Saf. 2020 Sep 7;5(5):e341. doi: 10.1097/pq9.0000000000000341. eCollection 2020 Sep-Oct.

Authors

Susan R Conway^{1

2}, Ken Tegtmeyer^{1

3}, Derek S Wheeler^{4

5}, Allison Loechtenfeldt⁶, Erika L Stalets^{3

7}, Patrick W Brady^{7

6}

Affiliations

¹ Division of Critical Care Medicine, Children's National Hospital, Washington, D.C.
² Department of Pediatrics, George Washington University School of Medicine, Washington, D.C.
³ Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
⁴ Division of Critical Care Medicine, Lurie Children's Hospital of Chicago, Chicago, Ill.
⁵ Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
⁶ Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
⁷ Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Abstract

Medical emergency teams (METs) bring critical care expertise to the bedsides of hospital ward patients who may be deteriorating. Diurnal variation in MET activation rates may identify inconsistencies in the detection of patients needing intervention. We aimed to determine whether such variation exists at our tertiary care children's hospital.

Methods: In this retrospective cohort study, we collected data including date and time of MET and disposition following MET for all inpatients at Cincinnati Children's Hospital Medical Center with a MET call between January 2008 and May 2014. The analysis compared the MET rate between days and nights, weekdays and weekends, and before and after nursing shift change.

Results: The number of METs per hour varied throughout the day. More METs were called during the day than at night (0.7 calls/shift ± 0.95 vs 0.6 ± 0.9, P < 0.001). There were also more METs per day on weekdays than weekends (1.4 ± 1 calls/d vs 1.2 ± 1, P < 0.001). Daytime METs were more likely to lead to transfer to the intensive care unit or operating room than those called at night (61.9% vs. 52.9%, P < 0.001). MET activation rates did not differ significantly in the 2 hours before nursing shift change compared to the 2 hours after.

Conclusions: At our large tertiary care children's hospital, there are both diurnal variations and variations across weekdays versus weekends in the MET activation rate. This difference may indicate variations in our ability to detect deteriorating patients on the wards and be further studied.