Timing and Location of Medical Emergency Team Activation Is Associated with Seriousness of Outcome: An Observational Study in a Tertiary Care Hospital

Abstract

PurposeThe medical emergency team (MET) can be activated anytime and anywhere in a hospital. We hypothesized the timing and location of MET activation are associated with seriousness of outcome.Materials and MethodsWe tested for an association of clinical outcomes with timing and location using a university hospital cohort in Japan (n = 328). The primary outcome was short-term serious outcome (unplanned ICU admission after MET activation or death at scene).ResultsPatients for whom the MET was activated in the evening or night-time had significantly higher rates of short-term serious outcome than those for whom it was activated during the daytime (vs. evening: adjusted OR = 2. 53, 95% CI = 1.24–5.13, P = 0.010; night-time: adjusted OR = 2.45, 95% CI = 1.09–5.50, P = 0.030). Patients for whom the MET was activated in public space had decreased short-term serious outcome compared to medical spaces (public space: adjusted OR = 0.19, 95% CI = 0.07–0.54, P = 0.0017). Night-time (vs. daytime) and medical space (vs. public space) were significantly associated with higher risks of unexpected cardiac arrest and 28-day mortality.ConclusionsPatients for whom the MET was activated in the evening/night-time, or in medical space, had a higher rate of short-term serious outcomes. Taking measures against these risk factors may improve MET performance.

First report based on the online registry of a Japanese multicenter rapid response system: a descriptive study of 35 institutions in Japan

“…Mortality was significantly higher during the night shift than during the day shift. Taking the high mortality rate in the night shift, which has been previously reported, 11 into consideration, different approaches to increase RRT/MET calls during the night shift are needed.…”

“…7 Although there are many reported studies of RRS in the world, very few have been reported from Japan; of these, most were reported from a single institution. [8][9][10][11][12] Therefore, detailed information with regard to Japanese epidemiological data for in-hospital emergencies is not available. In February 2014, the In-Hospital Emergency Registry in Japan (IHER-J), a multicenter RRS online registry, was introduced.…”

Shortening of low-flow duration over time was associated with improved outcomes of extracorporeal cardiopulmonary resuscitation in in-hospital cardiac arrest

“…who required immediate medical attention within the hospital grounds. All hospital staff could activate the RRS code in response to pre-defined criteria [13,14].…”

<p>Perioperative Medical Emergencies in a 23-Hour Surgical Procedure Unit</p>

“…An earlier observational study has demonstrated MET team activations in the evening or night-time to be associated with significantly higher short-term serious outcomes such as unplanned ICU admission and death. 9 An Australian-based retrospective observational study demonstrated that 53% of hospital-wide MET activations occurred out of peak staffing hours. 10 Our lower after hours incidence can be attributed to patient selection and the types of procedures performed.…”