• Ulf Theilen, Laura Fraser, Patricia Jones, Paul Leonard, and Dave Simpson.
• Royal Hospital for Sick Children, Edinburgh, 1 Sciennes Road, EH9 1LF, United Kingdom; University of Edinburgh, Child Life and Health, Edinburgh, 20 Sylvan Place, EH9 1UW, United Kingdom. Electronic address: ulf.theilen@luht.scot.nhs.uk.
• Resuscitation. 2017 Jun 1; 115: 61-67.

Aim Of The StudyThe introduction of a paediatric Medical Emergency Team (pMET) was accompanied by weekly in-situ simulation team training. Key ward staff participated in team training, focusing on recognition of the deteriorating child, teamwork and early involvement of senior staff. Following an earlier study [1], this investigation aimed to evaluate the long-term impact of ongoing regular team training on hospital response to deteriorating ward patients, patient outcome and financial implications.MethodsProspective cohort study of all deteriorating in-patients in a tertiary paediatric hospital requiring admission to paediatric intensive care (PICU) the year before, 1year after and 3 years after the introduction of pMET and team training.ResultsDeteriorating patients were recognised more promptly (before/1year after/3years after pMET; median time 4/1.5/0.5h, p<0.001), more often reviewed by consultants (45%/76%/81%, p<0.001) and more rapidly escalated to PICU (median time 10.5/5/3.5h, p=0.02). There was a significant reduction in associated PICU admissions (56/51/32, p=0.02) and PICU bed days (527/336/193, p<0.001). The total annual cost of training (£74,250) was more than offset by savings from reduced PICU bed days (£801,600 per annum). Introduction of pMET coincided with significantly reduced hospital mortality (p<0.001).ConclusionThese results indicate that lessons learnt by ward staff during team training led to sustained improvements in the hospital response to critically deteriorating in-patients, significantly improved patient outcomes and substantial savings. Integration of regular in-situ simulation training of medical emergency teams, including key ward staff, in routine clinical care has potential application in all acute specialties.Copyright © 2017. Published by Elsevier B.V.

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