Triage Travel Screening in the Pediatric ED: A Cross-Sectional Analysis to Evaluate Current Use and Effectiveness in Identifying Travel Related Illness.

OBJECTIVES: In 2014 the Center for Disease Control and Prevention recommended emergency departments (EDs) implement triage travel screening to identify persons at risk for Ebola Virus Disease (EVD). EVD remains rare in the United States, and in practice the triage travel screen serves as a de facto screen for all travel-related illnesses. This study seeks to determine the current use and effectiveness of the triage travel screen to detect travel-related illness in the pediatric ED. METHODS: This was a retrospective, cross-sectional study of visits across three pediatrics EDs in 2019 in Atlanta, GA. Prevalences of travel-related illnesses were compared between patients with positive and negative travel screens. Patient charts with diagnoses of travel-related illness were then reviewed. RESULTS: Out of 244,841 patient encounters during the study period, 13 patients with travel-related illness were identified. 5/13 cases of travel-related illness were not diagnosed at the initial ED visit. Of these 5 cases, 2 had correctly negative travel screens (as travel was not within the specified timeframe) and 3 had correctly positive travel screens, but none had a clinician-documented travel history in the ED clinical notes. Of the 8/13 cases that were diagnosed at the initial ED visit, 7/8 had a clinician-documented travel history in the ED note. CONCLUSIONS: This study highlights the limitations of the current pediatric ED triage travel screen to detect travel-related illness and reinforces the importance of a provider-taken travel history. Strategies to increase provider-administered travel history documentation and revisions to increase triage travel-screen efficacy should be considered.

Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit.

OBJECTIVE: We implemented a medical emergency team (MET) in our free-standing children's hospital. The specific aim was to reduce the rate of codes (respiratory and cardiopulmonary arrests) outside the intensive care units by 50% for >6 months following MET implementation. DESIGN: Retrospective chart review and program implementation. SETTING: A children's hospital. PATIENTS: None. INTERVENTIONS: The records of patients who required cardiorespiratory resuscitation outside the critical care areas were reviewed before MET implementation to determine activation criteria for the MET. Codes were prospectively defined as respiratory arrests or cardiopulmonary arrests. MET-preventable codes were prospectively defined. The incidence of codes before and after MET implementation was recorded. MEASUREMENTS AND MAIN RESULTS: Twenty-five codes occurred during the pre-MET baseline compared with six following MET implementation. The code rate (respiratory arrests + cardiopulmonary arrests) post-MET was 0.11 per 1,000 patient days compared with baseline of 0.27 (risk ratio, 0.42; 95% confidence interval, 0-0.89; p = .03). The code rate per 1,000 admissions decreased from 1.54 (baseline) to 0.62 (post-MET) (risk ratio, 0.41; 95% confidence interval, 0-0.86; p = .02). For MET-preventable codes, the code rate post-MET was 0.04 per 1,000 patient days compared with a baseline of 0.14 (risk ratio, 0.27; 95% confidence interval, 0-0.94; p = .04). There was no difference in the incidence of cardiopulmonary arrests before and after MET. For codes outside the intensive care unit, the pre-MET mortality rate was 0.12 per 1,000 days compared with 0.06 post-MET (risk ratio, 0.48; 95% confidence interval, 0-1.4, p = .13). The overall mortality rate for outside the intensive care unit codes was 42% (15 of 36 patients). CONCLUSIONS: Implementation of a MET is associated with a reduction in the risk of respiratory and cardiopulmonary arrest outside of critical care areas in a large tertiary children's hospital.