Effect of introduction of an integrated electronic medical record system with semi-automated multi-trigger MET alerts on utilisation of a paediatric RRS and patient outcome

Abstract

BACKGROUND: Queensland Children's Hospital (QCH) uses the Children's Early Warning Tool (CEWT) to identify deterioration and recommend actions such as Medical Emergency Team (MET) activation. In April 2018, QCH implemented an integrated electronic medical record (ieMR) for calculating CEWT scores and a semi-automated trigger system for rapid response system (RRS) activation. This offered a mechanism to decrease obstacles to RRS activation but raised concerns of reduced clinician decision-making and increased unnecessary MET involvement. METHODS: RRS activations from May 2016 to April 2020 were included. Pre- and post-intervention measures included MET dose, hospital mortality rate, in-hospital cardiac arrest (IHCA) rate, and unplanned paediatric intensive care unit (PICU) admission rates. Descriptive statistics and interrupted time series (ITS) with segmental regression assessed trends and intervention impact. OBJECTIVES: The primary objective was to assess changes in RRS activation frequency two years before and after implementation. Secondary objectives included assessing clinical outcomes: inpatient mortality rate and unplanned PICU admissions requiring emergency interventions within 6 h of transfer. RESULTS: 1284 eligible RRS activations were recorded. Post-intervention: MET dose increased 20 % (8.33 versus 6.90, p < 0.05), mean ward mortality rate decreased 52 % (0.16 versus 0.33, p < 0.05), and unplanned PICU admission rate (non-MET) decreased 15 % (3.42 versus 4.03, p < 0.05). IHCA rate, frequency of unplanned PICU admission (post-MET), or rates of emergency intervention within 6 h of PICU admission demonstrated no significant changes. CONCLUSIONS: The semi-automated trigger for RRS activation suggested an effect of decreasing obstacles to RRS activation without associated with extra "unnecessary work" or delays in activation.