Cincinnati Children’s Hospital Medical Center
Cincinnati Children’s Hospital
Introduction: Our center initiated a rapid response team, called a Medical Response Team (MRT) in July of 2006. Family activation of the MRT was delayed due to concerns expressed by the staff. Concerns included: 1) large time commitment to educate families on the activation process for an MRT; 2) possible calls of MRTs for non-clinical concerns; and 3) increased MRT activations that would overwhelm the system. Family-activation began in October 2007. Using improvement science and rapid cycle tests of change, interventions included educating parents about the MRT process as part of their unit orientation and posters which mapped the MRT process posted in each patient bedroom.
Hypothesis: The primary purpose of this study is to describe the number of family-activated MRTs and the number of MRT activations by staff that were prompted by family concerns since inception of the program, five years ago. The secondary purpose is to compare the disposition of MRT calls (to a higher level of care or not) in all MRT activations, in family-activated MRTs, and in MRTs where family concerns were expressed to staff.
Methods: Our study site is a large, free-standing, academic, quaternary care children’s hospital. In this retrospective cohort study we report time series data on MRT activations. Our primary exposure was family activation of MRT or family concern expressed to staff that led to MRT activation. Our primary outcome was disposition to a higher level of care. Time series data is presented on run charts, and bivariate associations between exposures and outcomes were tested with chi-square tests. A semi-structured chart review was conducted to obtain reasons for family activations.
Results: Since our program of family activation began in October of 2007, we have had a total of 36 family-activated MRTs (median: 1 per quarter; mean: 1.9 per quarter) (Figure). This is unchanged since our program began. MRT calls from staff following family concerns have significantly increased from 1 to 11 calls per quarter. Over the last 7 months, our center has a median of 62 MRT calls per month of which 0.7% are activated by families. Of all MRT activations, 7% are attributable to staff calling the MRT based on family concerns. Family activated MRTs less commonly result in transfer to the ICU as compared to staff activated calls (25% vs. 59%, p<0.001). Similar to all MRT calls, 58% of calls based on family concerns are transferred to a higher level of care. Families activated MRTs when they were concerned about a change in clinical condition of their child, were uncomfortable with the plan of care, and/or felt the response of the healthcare team was inadequate.
Conclusions: Despite concerns from clinicians, involving parents in the MRT process did not significantly increase the number of MRT activations. Our data suggests families recognize signs of early clinical deterioration in their children and play a vital role in formulating the patient plan of care in conjunction with the health care team.