0
The Pediatric Forum |

Rapid Response Team Implementation in a Children’s Hospital—Reply

Ari R. Joffe, MD; Natalie R. Anton, MD; Shauna C. Burkholder, MD
Arch Pediatr Adolesc Med. 2011;165(12):1139-1140. doi:10.1001/archpedi.165.12.1139-b.
Text Size: A A A
Published online

Extract

In reply

We thank Sharek et al for their comments. We disagree with the conclusion that their study design was sufficient to show efficacy of pediatric medical emergency team (PMET) implementation.

First, the statistical technique of ARIMA time-series analysis is superior to simple before-and-after comparisons, as it can model the effects of random error over time. We do not believe that ARIMA can “eliminate the biases of a simple before-and-after design,” completely account for unmeasured confounding factors that are temporally coincident (or even temporally related by delayed effects) to the intervention, nor solve the problem of systematic bias noted in studies involving historical controls.13 With only 19 postimplementation event rates in their ARIMA model,4 there is risk of type I error.1 A recent publication graphs 8 additional postimplementation event rates: hospital mortality increased again, and the ARIMA model parameter estimate for PMET intervention was no longer visually or statistically significant (Figure 1 and Table 3).5 Moreover, the hospital had several quality interventions (infection and adverse drug event reduction strategies and creation of a hospitalist program) implemented over the period of the PMET study that may be confounders.5 Of note, ARIMA was not used for analysis of ward code rates.4 More than 40% of deaths were in “newborns and other neonates with conditions originating in the perinatal period”; improvements may have been driven by perinatal care and less by care in the general pediatric population.4

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

December 1, 2011
Paul J. Sharek, MD, MPH; Layla M. Parast, MS; Stephen J. Roth, MD, MPH
Arch Pediatr Adolesc Med. 2011;165(12):1139-1140. doi:10.1001/archpedi.165.12.1139-a.
CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();