Medical emergency teams at the ottawa Hospital: the first two years

Abstract

Purpose: Medical emergency teams (MET) merge earlier-thanconventional treatment of worrisome vital signs with a skilled resuscitation response team, and may possibly reduce cardiac arrests, postoperative complications, and hospital mortality. Methods:At the two sites of The Ottawa Hospital, MET was introduced in January 2005. We reviewed call diagnoses, interventions, and outcomes from MET activity, and examined outcomes [cardiac arrests, intensive care unit (ICU) admissions, and readmissions] from Health Records and the ICU database. We compared the first fully operational year, 2006, with pre-MET years, 2003-4. Results:In 5,741 patient encounters, the teams (nurse, respiratory therapist, and intensivist) responded to 1,931 calls over two years, predominantly for high-risk in-patients. As well, there were 3,810 follow-up visits to these patients and to recently discharged ICU patients. In 2006, there were 40.3 calls/team/1,000 hospital admissions, with 71.2% of in-patient ICU admissions preceded by MET calls. Patient illness severity scores decreased from 4.9 ± 2.6 (mean ± SD) before implementing MET to 2.9 ± 2.3 (P < 0.0001) after MET interventions. Intervention on the respiratory system was performed on 72% of patients. Admission to the ICU occurred in 27% of MET patients. Compared with the pre-MET period, we observed decreases in: cardiac arrests (from 2.53 ± 0.8 to 1.3 ± 0.4 /1,000 admissions, P < 0.001); ICU admissions from in-patient nursing units/month (42.3 ± 7.3 to 37.6 ± 5.1, P = 0.05); readmissions after ICU discharge/month (13.5 ± 5.1 to 8.8 ± 4.5, P = 0.01); and readmissions within 48 hr of ICU discharge/month (4.4 ± 2.4 to 2.8 ± 1.0 ICU readmissions/month, P = 0.01). Conclusions: Successful implementation of MET reduces patient morbidity and ICU resource utilization. (42,3 ± 7,3 à 37,6 ± 5,1, P = 0,05) ; réadmissi-ons après congé des USI/mois (13,5 ± 5,1 à 8,8 ± 4,5, P = 0,01)

Effect of a Rapid Response Team on Patient Outcomes in a Community-Based Teaching Hospital

“…These results differ from early published studies on the use of rapid response teams, which found a decrease in mortality and morbidity. 4,6,7,11,14,15 A recent meta-analysis found that rapid response teams did not increase survival, but they tended to decrease out-of-intensive care unit cardiopulmonary arrests. 6 Other reviews showed similar conclusions.…”

“…2,3 Poor outcomes may be avoided by early detection of signs and symptoms suggesting patient deterioration, particularly cardiovascular instability. 4 Rapid response teams have been studied in a variety of situations and settings. [5][6][7][8][9][10] Teams typically comprise medical, nursing, and respiratory staff, who respond to predetermined changes in patient status in the inpatient, nonintensive care setting.…”

Postoperative Emergency Response Team Activation at a Large Tertiary Medical Center

“…Although this initiative intuitively appears effective, ERT outcomes are difficult to assess. ERT intervention may reduce ICU resource utilization 9 and immediate mortality after cardiac arrest. 3,6,[10][11][12][13] However, a large meta-analysis did not find evidence that these initiatives reduce the overall in-hospital mortality.…”

Critical care services in Ontario: a survey-based assessment of current and future resource needs

“…health.gov.on.ca/criticalcare), namely, the implementation of medical emergency teams. 27 The implications of increasing demand in the face of a relatively fixed supply of critical care resources will have a significant impact on both health care providers and critically ill patients. A recent study from the United Kingdom, where ICU beds are chronically lacking, suggests that physicians may develop ''prognostic pessimism'', leading them to refuse ICU admission to many seriously ill patients.…”