Hospital administrators are always looking for ways to improve the equation of how to advance quality of care at a lower cost. A cost-benefit analysis performed by a research team at The Children’s Hospital of Philadelphia describes one winning combination that can improve the safety of hospitalized children, while at the same time achieving financial savings.
Finding ways to better identify and respond to children who are getting sicker out on the pediatric wards has been a research focus of Christopher P. Bonafide, MD, MSCE, of the Division of General Pediatrics at the Children’s Hospital of Philadelphia, so he is a big METs fan (but we are not talking about baseball).
METs are medical emergency teams that involve critical care experts who are designated to be deployed to a unit when a patient is starting to show signs of clinical deterioration (CD), in order to head off cardiac arrests and other serious events that could require a transfer to the intensive care unit and life-sustaining interventions.
“Prior to implementation of medical emergency teams, you would call a Code Blue,” Dr. Bonafide said. “That’s when you’ve already missed all the warning signs, and the patient essentially is starting to die in front of you.”
Research has demonstrated that METs are effective in preventing CD events, but until Dr. Bonafide and his colleagues published a recent paper in Pediatrics, no studies had evaluated their financial benefits. First, the research team identified the cost of CDs, and then they analyzed various MET compositions and staffing models, in order to determine the annual reduction in CD events needed to offset MET costs.
“When you’re taking people who are doing critical care and moving them out onto the units to respond to patients, questions can come up: Is that the best use of their time? Is that providing a high value service?” Dr. Bonafide said. “It’s nice to see that some of what we’re already doing and know improves patient safety, we also can justify financially.”
In order to calculate the costs of CDs, the study team compared unplanned ICU transfers that did not require subsequent life-sustaining interventions to unplanned ICU transfers that required initiation of noninvasive or invasive mechanical ventilation and vasopressor infusion. They determined that a hospital can potentially save $100,000 every time a MET can quickly assess and stabilize a patient without the need for life-sustaining interventions.
Next, the researchers tackled some complicated math. Since there is no single way to stack a MET, they had to consider several configurations to estimate the costs of running those teams. They looked at 75th percentile salaries for a nurse, respiratory therapist, critical care fellow, and ICU attending as the folks who might make up the MET. They also took into consideration if those responders had any other concurrent responsibilities, or if they were part of a freestanding unit that is staffed 24 hours a day.
“Based on how you staff your MET, it varies a ton on what the team actually costs,” said Dr. Bonafide, who also is an assistant professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania. “The correlate to that is the number of critical deterioration events that you actually have to prevent. So if you have an inexpensive team model, you actually don’t have to prevent that many events in order for the team to pay for itself.”
The MET at Children’s Hospital consists of a critical care fellow, a respiratory therapist, and a nurse who have concurrent responsibilities, which is the most common MET configuration in the U.S. Based on that model, the investigators calculated that in order to recoup MET costs, the team has to prevent between three and four critical deterioration events for the entire year.
“That really is not a difficult thing to do,” Dr. Bonafide said. “We know that we can have a significant impact on these bad outcomes by implementing medical emergency teams, so the three to four number is very attainable.”
The financial benefits could add up significantly. In a hospital that has approximately 300 unplanned transfers from ward to ICU per year, a reduction of 15 CD events per year by implementing CHOP’s MET model could result in eliminating $1,496,595 in excess costs per year for a net savings of $1,145,897 annually, the researchers wrote in the Pediatrics paper.
A future research challenge will be to determine what percentage of CD events are preventable, Dr. Bonafide pointed out. Another question he would like to consider is how cost-effective are METs, which takes into account how the teams’ interventions could impact not only the costs of care but also quantify the years of lives saved and patients’ quality of life.