Closer to understanding the value proposition for medical emergency teams.

Medical emergency teams (METs) are common features of adult and pediatric hospitals and have been accepted as beneficial by many in health care, including regulatory agencies. In pediatrics, the value (quality outcome / cost) derived from operating METs is not known. Bonafide et al report the first significant effort in children to address MET value by detailing costs, in their large children’s hospital, associated with patient critical deteriorations (CDs) and MET operations. To account for differing structures, Bonafide et al 10 calculate MET operating costs by modeling various commonly deployed MET staffing compositions and whether the team is freestanding or comprises individuals with concurrent responsibilities. After adjusting for multiple confounders, the authors report that total hospital costs after unplanned admissions to the ICU for patients suffering CD are $99 773 greater than for unplanned ICU admissions without CD. Annualizing MET operating costs and utilizing the aforementioned CD costs, the authors estimate that if an MET, as commonly deployed in many hospitals, prevented 3.5 CDs, then the savings associated with the need to provide less emergency critical care services would offset total MET operating costs. This analysis, in combination with previous work linking reductions in non-ICU cardiopulmonary arrests and MET implementation, makes a persuasive case that METs achieve meaningful end points in a value-added way. Bonafide’s work is important and encouraging, but it provokes issues that merit additional discussion.