The patient‐at‐risk team: identifying and managing seriously ill ward patients

Goldhill, D. R.; Worthington, L M; Mulcahy, A J; Tarling, Maggie; Sumner, Anne E.

doi:10.1046/j.1365-2044.1999.00996.x

Cited by 336 publications

(188 citation statements)

References 11 publications

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“…These teams have become popular over recent years, following publication of British and Australian studies. [5][6][7][8][9][10][11][12][13][14][15][16][17] The intent of CCO (nurse led) or MET (physician led) units is to identify patients at risk before deterioration to respiratory, circulatory, or multi-system organ dysfunction, thus avoiding ICU admission, or even preventing cardiac arrest.…”

Section: Résultats : Sur 5741 Visites Les éQuipes (Infirmière Inhalmentioning

confidence: 99%

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

Baxter

Cardinal

Hooper

et al. 2008

Can J Anesth/J Can Anesth

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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)

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Section: Résultats : Sur 5741 Visites Les éQuipes (Infirmière Inhalmentioning

confidence: 99%

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

Baxter

Cardinal

Hooper

et al. 2008

Can J Anesth/J Can Anesth

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“…15 Although published reports 13,14,[16][17][18][19][20][21][22][23][24] suggest that data are inconclusive about the overall effect of implementation of MET systems on patients' outcomes in acute care hospitals, at present the MET system continues to be broadly introduced. 17,18,25,26 The MET system is most commonly activated by nurses outside the ICU, including both registered nurses and licensed practical nurses. 18 Although the MET system embodies the ability to empower nurses to seek early assistance for managing acutely ill patients outside the ICU, few data are available on nurses' beliefs and attitudes about the MET system.…”

mentioning

confidence: 99%

A Survey of Nurses' Beliefs About the Medical Emergency Team System in a Canadian Tertiary Hospital

Bagshaw

Mondor²,

Scouten³

et al. 2009

American Journal of Critical Care

113

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Background Nurses are the primary activators of the medical emergency team (MET). Although the MET system can empower nurses to seek help in managing acutely ill patients, few data on nurses' beliefs about the system are available. Objective To evaluate nurses' beliefs and behaviors about the MET system. Methods Nurses from a large academic hospital in Canada were surveyed (2 demography-related questions and 17 Likert-scale questions). Results Of 614 nurses employed on units participating in the MET system, 293 (47.7%) were approached and 275 completed the survey (response rate, 93.9%). Most respondents (84.2%) believed that the MET could prevent cardiopulmonary arrest in acutely ill patients, and 94% believed that the MET allowed them to seek help for patients they were worried about. Most nurses (75.9%) would call the responsible physician before activating the MET. Fifteen percent indicated reluctance to activate the MET because of fear of criticism, but only 2.2% considered the MET overused. Most (81.3%) believed that the MET did not increase their workload, and 91.3% did not believe that the MET reduced their skills. Forty-eight percent of nurses indicated that they would activate the MET for a patient they were worried about, even if the patient had normal vital signs. Conclusion Nurses value the MET system. Nurses believe that the MET can help them care for acutely ill patients and improve outcomes. However, barriers to MET activation exist, including a fear of criticism and an adherence to a more traditional model of first contacting the responsible physician before activating the MET.

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“…15 Initial studies of RRSs, performed primarily in Australia and the United Kingdom, showed promising reductions in unanticipated ICU admissions, cardiac arrests, and even overall inpatient mortality. 1,16,17 The considerable enthusiasm generated by these studies 18,19 resulted in the Institute for Healthcare Improvement (IHI) incorporating RRSs into its "100,000 Lives" campaign, 2 and RRSs are now being implemented in the more than 3000 U.S. hospitals that joined the campaign. However, a recent commentary on rapid response teams 20 and a systematic review of critical care outreach teams 21 have raised concerns that this widespread implementation may not be justified by the available evidence.…”

mentioning

confidence: 99%

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Ranji

Auerbach

Hurd

et al. 2007

Journal of Hospital Medicine

100

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BACKGROUNDA rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster‐randomized trial.PURPOSETo evaluate the effects of RRSs on clinical outcomes through a systematic literature review.DATA SOURCESMEDLINE, BIOSIS, and CINAHL searches through August 2006, review of conference proceedings and article bibliographies.STUDY SELECTIONRandomized and nonrandomized controlled trials, interrupted time series, and before‐after studies reporting effects of an RRS on inpatient mortality, cardiopulmonary arrests, or unscheduled ICU admissions.DATA EXTRACTIONTwo authors independently determined study eligibility, abstracted data, and classified study quality.DATA SYNTHESISThirteen studies met inclusion criteria: 1 cluster‐randomized controlled trial (RCT), 1 interrupted time series, and 11 before‐after studies. The RCT showed no effects on any clinical outcome. Before‐after studies showed reductions in inpatient mortality (RR = 0.82, 95% CI: 0.74‐0.91) and cardiac arrest (RR = 0.73, 95% CI: 0.65‐0.83). However, these studies were of poor methodological quality, and control hospitals in the RCT reported reductions in mortality and cardiac arrest rates comparable to those in the before‐after studies.CONCLUSIONSPublished studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before‐after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven. Journal of Hospital Medicine 2007;2:422–432. © 2007 Society of Hospital Medicine.

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The patient‐at‐risk team: identifying and managing seriously ill ward patients

Cited by 336 publications

References 11 publications

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

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

A Survey of Nurses' Beliefs About the Medical Emergency Team System in a Canadian Tertiary Hospital

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

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