Bonafide CP, Localio AR, Song L, Roberts KE, Nadkarni VM, Priestley M, Paine CW, Zander M, Lutts M, Brady PW, Keren R. Pediatrics 2014; 134(2): 235-241.
Affiliation
Division of General Pediatrics,Departments of Pediatrics,Center for Pediatric Clinical Effectiveness,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and.
OBJECTIVES: Medical emergency teams (METs) can reduce adverse events in hospitalized children. We aimed to model the financial costs and benefits of operating an MET and determine the annual reduction in critical deterioration (CD) events required to offset MET costs.
METHODS: We performed a single-center cohort study between July 1, 2007 and March 31, 2012 to determine the cost of CD events (unplanned transfers to the ICU with mechanical ventilation or vasopressors in the 12 hours after transfer) as compared with transfers to the ICU without CD. We then performed a cost-benefit analysis evaluating varying MET compositions and staffing models (freestanding or concurrent responsibilities) on the annual reduction in CD events needed to offset MET costs.
RESULTS: Patients who had CD cost $99 773 (95% confidence interval, $69 431 to $130 116; P <.001) more during their post-event hospital stay than transfers to the ICU that did not meet CD criteria. Annual MET operating costs ranged from $287 145 for a nurse and respiratory therapist team with concurrent responsibilities to $2 358 112 for a nurse, respiratory therapist, and ICU attending physician freestanding team. In base-case analysis, a nurse, respiratory therapist, and ICU fellow team with concurrent responsibilities cost $350 698 per year, equivalent to a reduction of 3.5 CD events.
CONCLUSIONS: CD is expensive. The costs of operating a MET can plausibly be recouped with a modest reduction in CD events. Hospitals reimbursed with bundled payments could achieve real financial savings by reducing CD with an MET.