Recommended guidelines for monitoring, reporting, and conducting research on medical emergency team, outreach, and rapid response systems: An Utstein-style scientific statement

Background According to the rapid response system’s team composition, responding teams were named as rapid response team (RRT), medical emergency team (MET), and critical care outreach. A RRT is often a nurse-led team, whereas a MET is a physician-led team that mainly plays the role of an efferent limb. As few multicenter studies have focused on physician-led METs, we comprehensively analyzed cases for which physician-led METs were activated. Methods We retrospectively analyzed cases for which METs were activated. The study population consisted of subjects over 18 years of age who were admitted in the general ward from January 2016 to December 2017 in 9 tertiary teaching hospitals in Korea. The data on subjects’ characteristics, activation causes, activation methods, performed interventions, in-hospital mortality, and intensive care unit (ICU) transfer after MET activation were collected and analyzed. Results In this study, 12,767 cases were analyzed, excluding those without in-hospital mortality data. The subjects’ median age was 67 years, and 70.4% of them were admitted to the medical department. The most common cause of MET activation was respiratory distress (35.1%), followed by shock (11.8%), and the most common underlying disease was solid cancer (39%). In 7,561 subjects (59.2%), the MET was activated using the screening system. The commonly performed procedures were arterial line insertion (17.9%), intubation (13.3%), and portable ultrasonography (13.0%). Subsequently, 29.4% of the subjects were transferred to the ICU, and 27.2% died during hospitalization. Conclusions This physician-led MET cohort showed relatively high rates of intervention, including arterial line insertion and portable ultrasonography, and low ICU transfer rates. We presume that MET detects deteriorating patients earlier using a screening system and begins ICU-level management at the patient’s bedside without delay, eventually preventing the patient’s condition from worsening and transfer to the ICU.

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Proceedings of the 12th International Conference on Rapid Response Systems and Medical Emergency Teams

Anaesthesia and Intensive Care ◽

10.1177/0310057x1704500416 ◽

2017 ◽

Vol 45 (4) ◽

pp. 511-517 ◽

Cited By ~ 3

Author(s):

D. Jones ◽

J. Holmes ◽

J. Currey ◽

E. Fugaccia ◽

A. J. Psirides ◽

...

Keyword(s):

Care Setting ◽

Rapid Response ◽

Medical Emergency ◽

Acute Care Setting ◽

Rapid Response Teams ◽

International Conference ◽

Rapid Response Systems ◽

Hospitalised Patients ◽

Medical Emergency Teams ◽

Response Systems

Rapid Response Teams (RRTs) have been introduced into hospitals worldwide in an effort to improve the outcomes of deteriorating hospitalised patients. Recently, there has been increased awareness of the need to develop systems other than RRTs for deteriorating patients. In May 2016, the 12th International Conference on Rapid Response Systems and Medical Emergency Teams was held in Melbourne. This represented a collaboration between the newly constituted International Society for Rapid Response Systems (iSRRS) and the Australian and New Zealand Intensive Care Society. The conference program included broad ranging presentations related to general clinical deterioration in the acute care setting, as well as deterioration in the emergency department, during pregnancy, in the paediatric setting, and deterioration in mental health status. This article briefly summarises the key features of the conference, links to presentations, and the 18 abstracts of the accepted free papers.

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Improving rapid response system performance in a Chinese Joint Commission International Hospital

Journal of International Medical Research ◽

10.1177/0300060519850452 ◽

2019 ◽

Vol 47 (7) ◽

pp. 2961-2969

Author(s):

Minfei Yang ◽

Lanlan Zhang ◽

Yuwei Wang ◽

Yue Zhan ◽

Xiaofei Zhang ◽

...

Keyword(s):

Medical Emergency Team ◽

Joint Commission ◽

Rapid Response ◽

Medical Emergency ◽

Rapid Response System ◽

Serious Adverse Events ◽

Emergency Team ◽

Response System ◽

Joint Commission International ◽

The Impact

Objective To assess the impact of a regional rapid response system (RRS) implemented in a Chinese Joint Commission International Hospital on the timely treatment of patients with serious adverse events (SAEs). Methods Clinical SAEs, activation periods, reasons for RSS activation, and patient outcomes were assessed using SAE response sheets at admission to the hospital and over 31 months of follow-up. Results We found that 192 events were called by medical staff and 6 were called by auxiliary staff. Reasons for the 385 RRS activations included: unconsciousness (133; 34.5%), and airway obstruction and absent carotid pulse (49 each; 12.7%). The average arrival time of the medical emergency team was 2.4 ± 0.1 minutes. There were 123 (62.1%) RRS activations during daytime working hours (8:00–17:00); CPR was performed in 86 (43.4%) cases. Outcomes of RRS were: vital signs stabilized in 82 (41.4%) patients and 61 (30.8%) patients were transferred to ICU. Conclusion Our experience showed that the regional RRS has led to better integrated multidisciplinary cooperation and reduced time for treating patients with SAEs, resulting in success of the RRS.

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Abstract 264: Use of an Acronym to Reduce Medical Emergency Call Time and Improve Survival

Circulation ◽

10.1161/circ.138.suppl_2.264 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Karen M Graves ◽

Lee Anne Siegmund

Keyword(s):

Cardiopulmonary Arrest ◽

Medical Emergency Team ◽

Survival Rates ◽

Cleveland Clinic ◽

Rapid Response ◽

Medical Emergency ◽

Quality Improvement Initiative ◽

Emergency Team ◽

Clinically Important Difference ◽

The Right

Introduction: An average of 1500 medical emergencies are called to the operators each month for the main campus Cleveland Clinic. Acronyms can help the employee to remember necessary information to quickly and accurately activate the right medical emergency team in a short time. We developed the acronym LEAN (L-Location, E-Event Type; code or rapid response, A-Adult or Child, N-Call back number). We reduced the length of the call which led to the prompt activation of the medical emergency team. Hypothesis: We hypothesized that this quality improvement initiative, using the LEAN acronym would: 1. Reduce length of call time to the operator and 2. Lead to increased event survival of event for patients who have had a life-threatening medical emergency. Methods: The LEAN acronym was implemented in 2016 by sharing this acronym at staff meetings, and daily huddles. We developed an operator scorecard which tracked the average call time to the 111 (code) and 122 (rapid response) operator lines before and after LEAN implementation. We used our AHA Get With The Guidelines-Resuscitation® data to determine cardiopulmonary arrest (CPA) event survival. Results: Since August of 2016 we have reduced our 122 rapid response calls by 30 seconds and our 111 code calls by 12 seconds. CPA survival rates were 73% (437 of 599) in 2015 and 78.9% (548 of 703) in 2017, for an 8.1% increase ( Figure 1 ). While there is not a statistically significant ( p = 0.511) difference between time periods when we look at percentage of lives saved, the number of lives saved increased. This is a clinically important difference because more people survived. We plan to continue to disseminate LEAN and work to improve response time. Conclusion: Since we introduced LEAN there has been a reduction in the time to activation of our medical emergency teams and an 8% increase in our GWTG-R® Cardiopulmonary Arrest event survival. Lives were saved and LEAN may have played a role in this clinically important difference.

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Factors associated with delayed activation of medical emergency team and excess mortality: An Utstein-style analysis

Resuscitation ◽

10.1016/j.resuscitation.2012.09.021 ◽

2013 ◽

Vol 84 (2) ◽

pp. 173-178 ◽

Cited By ~ 50

Author(s):

Joonas Tirkkonen ◽

Jari Ylä-Mattila ◽

Klaus T. Olkkola ◽

Heini Huhtala ◽

Jyrki Tenhunen ◽

...

Keyword(s):

Excess Mortality ◽

Medical Emergency Team ◽

Medical Emergency ◽

Style Analysis ◽

Emergency Team ◽

Factors Associated ◽

Utstein Style

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A ten year check-up for a rapid response system—Revitalizing our medical emergency team

Australian Critical Care ◽

10.1016/j.aucc.2010.12.050 ◽

2011 ◽

Vol 24 (1) ◽

pp. 72

Author(s):

N. Pratt ◽

J. Molloy ◽

J. Botha ◽

T. Tobias ◽

S. White ◽

...

Keyword(s):

Medical Emergency Team ◽

Rapid Response ◽

Medical Emergency ◽

Rapid Response System ◽

Emergency Team ◽

Response System

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Utility and assessment of non-technical skills for rapid response systems and medical emergency teams

Internal Medicine Journal ◽

10.1111/imj.12172 ◽

2013 ◽

Vol 43 (9) ◽

pp. 962-969 ◽

Cited By ~ 22

Author(s):

R. P. Chalwin ◽

A. Flabouris

Keyword(s):

Technical Skills ◽

Rapid Response ◽

Medical Emergency ◽

Rapid Response Systems ◽

Medical Emergency Teams ◽

Response Systems

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Outcomes following changing from a two-tiered to a three-tiered hospital rapid response system

Australian Health Review ◽

10.1071/ah17105 ◽

2019 ◽

Vol 43 (2) ◽

pp. 178

Author(s):

The Concord Medical Emergency Team Study Investigators

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Patient Outcomes ◽

Medical Emergency Team ◽

Rapid Response ◽

Medical Emergency ◽

Rapid Response System ◽

Structured Interviews ◽

Emergency Team ◽

Response System

Objectives The aim of the present study was to determine whether changing a hospital rapid response system (RRS) from a two-tiered to a three-tiered model can reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. Methods Staff at an Australian teaching hospital attending medical emergency team and cardiac arrest (MET/CA) calls were interviewed after the RRS was changed from a two-tiered to three-tiered model, and the results were compared with a study using the same methods conducted before the change. The main outcome measures were changes in: (1) the incident rate resulting from staff leaving normal duties to attend MET/CA calls; (2) the cardiac arrest rate, (3) unplanned intensive care unit (ICU) admission rates; and (4) hospital mortality. Results We completed 1337 structured interviews (overall response rate 65.2%). The rate of incidents occurring as a result of staff leaving normal duties to attend MET/CA calls fell from 213.7 to 161.3 incidents per 1000 MET/CA call participant attendances (P<0.001), but the rate of cardiac arrest and unplanned ICU admissions did not change significantly. Hospital mortality was confounded by the opening of a new palliative care ward. Conclusion A three-tiered RRS may reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. What is known about the topic? RRS calls result in significant disruption to normal hospital routines because staff can be called away from normal duties to attend. The best staffing model for an RRS is currently unknown. What does this paper add? The present study demonstrates, for the first time, that changing a hospital RRS from a two-tiered to a three-tiered model can reduce the rate of incidents reported by staff caused by leaving normal duties to attend RRS calls while maintaining the same overall patient outcomes. What are the implications for practitioners? Hospitals could potentially reduce disruption to normal hospital routines, without compromising patient care, by changing to a three-tiered RRS.

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