Case study 5: Family-activated medical emergency teams
Global State of Patient Safety 2023
Country where the case study originated highlighted in red. Where relevant, additional countries where this programme has been implemented are highlighted in blue.
What is it?
Rapid response systems, comprising tools to identify deteriorating patients (such as monitoring of physiological markers) and a multi-disciplinary team (typically based within ICUs) to respond to medical emergencies, have been shown to reduce arrests and deaths in children in hospital. Typically ‘activated’ by clinicians, a team at Cincinnati Children’s Hospital developed a model where the emergency response team could be triggered by the families of hospitalised children.
Why was it developed?
Research suggests that families have unique knowledge about their child’s typical behaviour, and may recognise significant changes in it before clinicians do. The team believed that a family-activated system could tap into this recognition and improve the response and outcomes for deteriorating children.
Although not a new idea, there was a perceived lack of evidence to allay clinician concerns, namely that the intervention would lead to: a dramatic increase in the number of Medical Emergency Teams (MET) calls activated, impacting on other patients; calls being made for non-emergency issues; and a significant time burden on staff to educate parents about the system.
Evaluation of the system generated compelling retrospective evidence that families were seeing things that clinical teams weren’t seeing – “it was novel information, not redundant information” – and family activated METs accounted for less than 3% of calls.
How can it be adopted?
Some practical steps were found to be effective when implementing the system. First, ensuring that families know who their primary team is, and how to ask questions and escalate concerns quickly and efficiently – this can form part of a good orientation. Second, that attention is paid to communication and signage:
“…when there’s additional concerns about a child – we call them ‘watchers’ – this is posted on the door, so that the family can see it, read it, review it, and quality check it… and make sure families know what to look out for, and what are the particularly worrisome signs…it’s a low tech, but cool innovation.”
Third, that families are strongly encouraged to use the system:
“…it’s funny to have to say this, but if you do this, your biggest challenge is likely going to still be encouraging families to call, rather than dealing with too many families that call, because we showed that the call volumes are relatively small, and they, without exception, were about something related to safety… and we could get in the weeds and say, ‘is delayed pain medicine related to safety rather than quality’, but they were things that the critical care system should have been doing better for kids, and this proved an accelerant to do it better.”
How can the measurement of patient safety be improved?
“We still have a lot of work to do in this space… I still haven’t seen a system that makes full activation, or close to full activation, of patients and families smooth and efficient in the hospital [particularly for] families that are new to the hospital, or are historically marginalised for other reasons.”
Key resources and contact details
Dr Pat Brady: patrick.brady@cchmc.org
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