Quality Improvement/Patient Safety: All Areas
QI 3: Subspecialty-specific QI & Patient Safety
Anna J. Sibilia, MD (she/her/hers)
Critical Care fellow
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States
Medical response teams (MRTs) are ubiquitous in hospitals and serve to assess, triage, and transfer patients needing intensive care. These teams are important for lowering rates of clinical deterioration events and emergent intensive care unit (ICU) transfers. Despite these benefits, there remains a proportion of transfers to the pediatric intensive care unit (PICU) that do not require critical care. Given the cost of ICU care and resource limitations, appropriate use of critical care services is crucial.
Objective:
Our objective was to prospectively characterize reasons for all MRT activations at a quaternary children’s hospital, and more specifically, the reason for MRT activation for patients who were found to be potentially avoidable ICU transfers.
Design/Methods:
The MRT-activating and ICU teams were surveyed to identify the reason for MRT activation. Reasons included: shock, respiratory distress, care needs beyond the current unit, neurologic change, general care concern, and parental concern. For PICU transfers, their PICU course was retrospectively reviewed. Patients not experiencing a clinical deterioration event (defined as initiation of positive pressure ventilation or vasoactive support within 12 hours of transfer) or patients not receiving several PICU-specific interventions were deemed to be potentially avoidable transfers (PATs). We referenced the survey results for these patients to understand the clinical concern at the time of transfer for PATs.
Results:
Over a 9 month period, we reviewed 456 MRT activations. Respiratory distress followed by care needs beyond those provided in the current unit (specifically the need for increased monitoring) were the most common reasons for all MRT activations. Nearly half (47%, 216/456) of all MRT activations resulted in PICU transfer. Of these, 46% (100/216) were deemed to be a PAT—they did not have a clinical deterioration event or require critical care interventions, such as escalation of respiratory or hemodynamic support. The most common reasons for MRT activation among PATs was similar to the entire cohort: respiratory distress followed by care needs beyond the current unit.
Conclusion(s):
A large proportion of patients transferring to the PICU following the MRT activation were potentially avoidable in our study. It may be beneficial to implement processes that can limit such transfers, thereby reducing strain on ICU resources and cost of care..png)