High Rate of Medical Emergency Team Activation in Children with Tracheostomy.

Pediatric in-patients with tracheostomy (PIT) are at high risk for clinical deterioration. Medical emergency teams (MET) have been developed to identify high-risk patients. This study compared MET activation rates between PITs and the general ward population. This was a retrospective cohort study conducted at a tertiary pediatric hospital. The primary outcome (MET activation) was obtained from a database. Between 2008 and 2014, the MET activation rate was significantly higher in the PIT group than the general ward population (14 vs. 2.9 per 100 admissions, p < 0.001). PITs are at significantly higher risk for MET activation. Strategies should be developed to reduce their risk on the wards.

A PICU patient safety checklist: rate of utilization and impact on patient care.

OBJECTIVE: In healthcare, checklists help to ensure patients receive evidence-based, safe care. Since 2007, we have used a bedside checklist in our PICU to facilitate daily discussion of care-related questions at each bedside. The primary objective of this study was to assess compliance with checklist use and to assess how often individual checklist elements affected patient management. A secondary objective was to determine whether patient and unit factors (severity of illness, unit census, weekday vs. weekend, admitting diagnosis group) influenced checklist use. DESIGN: This was a prospective observational study. A research assistant attended daily bedside rounds to collect data at each eligible patient encounter. SETTING: The study was conducted in the Children's Hospital of Eastern Ontario (CHEO) PICU, a 12-bed cardiac and medical-surgical unit. PARTICIPANTS: Included all patients admitted to the PICU prior to 6 am and who were not being discharged that day. INTERVENTION: A bedside rounds checklist. MAIN OUTCOME MEASURES: Included compliance and whether the checklist affected the patient's management plan. RESULTS: A total of 148 encounters were collected on 28 days between September 2013 and February 2014. Compliance with the checklist was 89.2% (132/148; 95% CI 83.2-93.2%) and was not influenced by admitting diagnosis group, patient census, severity of patient's conditions or weekday/weekend status. The checklist affected the patient management plan 52.6% of the time (69/132; 95% CI 44.2-61%). CONCLUSIONS: Our study found high rates of compliance with an established checklist that has been in use in the PICU since 2007. Checklist use frequently resulted in a change in the patient management plan.