147 - Development of a Communication Script for Medical Emergency Teams; Using Interdisciplinary Consensus Building Frameworks to Optimize Communication during Medical Emergency Team Activations

Publication Number: 3141.147

Elizabeth L. Kaufman, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Sanjiv D. Mehta, Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States; Steven Loscalzo, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Medical Emergency Teams (METs) are ICU teams that respond to hospitalized patients with risk of clinical deterioration. Effective performance requires optimal shared situation awareness between the ICU and floor teams to ensure appropriate triage and next steps.

Despite literature supporting the use of communication tools during exchange of patient information to improve patient safety, interdisciplinary inpatient care teams do not currently have a standardized method of communicating during MET activations. This is a barrier to optimal situation awareness and decision making for patients at risk for clinical deterioration, a key driver of in-hospital mortality.

Objective: To leverage multidisciplinary consensus building to develop and iteratively refine a standardized communication script for use during MET Activations.

Design/Methods: We held an in-person consensus building session to determine the essential components of an effective MET activation. A total of 24 clinicians participated, including pediatric critical care medicine (PCCM) and pediatric hospital medicine (PHM) physicians, nurses, and respiratory therapists (Table 1). Using the KJ Method (affinity diagram), clinicians brainstormed, grouped, labeled, and ranked ideas for effective communication (Image 1).

The results of this session were then used to develop a bidirectional communication tool. Additional feedback was elicited asynchronously with subsequent affinity diagrams and direct feedback after introduction of script iterations during stakeholder meetings. The final iteration uses a backbone of Situation Background Assessment Recommendation (SBAR), a validated communication tool used across our enterprise, and incorporates specific bidirectional language emphasized during the consensus building session.

Results: Output from the multidisciplinary consensus building KJ process identified 9 items essential for an effective MET Activation (Image 2). The highest ranked items were a clear request, explicit next steps, and professionalism. The results were then integrated into a novel, bidirectional communication script (Image 2).

Conclusion(s): We leveraged interdisciplinary expert opinion to develop a novel, bidirectional communication tool aimed at improving situation awareness and decision making for children with clinical deterioration.

Future directions include validation of the script in a simulated environment and staged implementation to measure the impact of the communication tool.

Table 1: Participants


Image 1: Flow Diagram of KJ Process


Image 2: Script Development
MET Activations are referred to as CAT (Critical Assessment Team) Calls at our institution. MET and CAT are used interchangeably.