scholarly journals Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results

2005 ◽  
Vol 90 (11) ◽  
pp. 1148-1152 ◽  
Author(s):  
J Tibballs
Keyword(s):  
Cardiac Arrest ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Emergency Team ◽  
Preliminary Results

The identification of risk factors for cardiac arrest and formulation of activation criteria to alert a medical emergency team

Resuscitation ◽  
2002 ◽  
Vol 54 (2) ◽  
pp. 125-131 ◽  
Author(s):  
Timothy J. Hodgetts ◽  
Gary Kenward ◽  
Ioannis G. Vlachonikolis ◽  
Susan Payne ◽  
Nicolas Castle
Keyword(s):  
Risk Factors ◽  
Cardiac Arrest ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Emergency Team ◽  
Activation Criteria

scholarly journals Outcome among patients suffering from in-hospital cardiac arrest

2014 ◽  
Vol 142 (3-4) ◽  
pp. 170-177
Author(s):  
Sladjana Trpkovic ◽  
Aleksandar Pavlovic ◽  
Vesna Bumbasirevic ◽  
Ana Sekulic ◽  
Biljana Milicic
Keyword(s):  
Cardiac Arrest ◽  
Continuous Monitoring ◽  
Life Support ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Hospital Treatment ◽  
Time Of Arrival ◽  
Technical Equipment ◽  
Emergency Team ◽  
Factors Associated

Introduction. In relation to pre-hospital treatment of patients with cardiac arrest (CA) in the field where resuscitation is often started by nonprofessionals, resuscitation in hospital is most commonly performed by well-trained personnel. Objective. The aim was to define the factors associated with an improved outcome among patients suffering from the inhospital CA (IHCA). Methods. The prospective study included a total of 100 patients in the Emergency Center over two-year period. The patterns by the Utstein-Style guidelines recorded the following: age, sex, reason for hospital admission, comorbidity, cause and origin of CA, continuous monitoring, time of arrival of the medical emergency team and time of delivery of the first defibrillation shock (DC). Results. Most patients (61%) had cardiac etiology. Return of spontaneous circulation (ROSC) was achieved in 58% of patients. ROSC was more frequently achieved in younger patients (57.69?11.37), (p<0.05), non-surgical patients (76.1%), (p<0.01) and in patients who were in continuous monitoring (66.7%) (p<0.05). The outcome of CPR was significantly better in patients who received advanced life support (ALS) (76.6%) (p<0.01). Time until the delivery of the first DC shock was significantly shorter in patients who achieved ROSC (1.67?1.13 min), (p<0.01). A total of 5% of IHCA patients survived to hospital discharge. Conclusion. In our study, the outcome of CPR was better in patients who were younger and with non-surgical diseases, which are prognostic factors that we cannot control. Factors associated with better outcome of IHCA patients were: continuous monitoring, shorter time until the delivery of the first DC and ALS. This means that better education of medical staff, better organization and up-to-dated technical equipment are needed.

Abstract 220: Missed Opportunity for Medical Emergency Team Activation in Pediatric In-Hospital Cardiac Arrest

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Natalie Jayaram ◽  
Maya L Chan ◽  
Fengming Tang ◽  
Paul S Chan
Keyword(s):  
Cardiac Arrest ◽  
Medical Emergency Team ◽  
Vital Signs ◽  
National Registry ◽  
Medical Emergency ◽  
Missed Opportunities ◽  
Emergency Team ◽  
Variable Success ◽  
Get With The Guidelines ◽  
Hospital Cardiac Arrest

Background: Prior studies of Medical Emergency Teams (METs) in pediatric hospitals have shown inconsistent results in terms of their ability to improve outcomes. Whether the variable success is due to differential utilization of METs among hospitals is unknown. Methods: Within the Get With The Guidelines-Resuscitation Registry (GWTG-R), we identified children (age <18 years) with an in-hospital cardiac arrest (IHCA) on the general inpatient or telemetry floors from 2007 to 2014. In cases of IHCA where MET evaluation did not occur, we examined the frequency of “missed” opportunities for activation of the MET based upon the presence of one or more abnormal vital signs. We also examined the variability in utilization of the MET among those hospitals with at least ten cases of IHCA. Results: Of 215 children from 23 hospitals sustaining an IHCA, 48 (22.3%) had a preceding MET evaluation. Children with MET evaluation prior to IHCA were older (6.8 ± 6.5 vs. 3.1 ± 4.7, p < 0.001) and were more likely to have metabolic/electrolyte abnormalities (9/48 [18.8%] vs. 9/167 [5.4%], p=0.006), sepsis (8/48 [16.7%] vs. 8/167 [4.8%], p=0.01), or malignancy (11/48 [22.9%] vs. 9/167 [5.4%], p<0.001) at the time of their IHCA. Hospital utilization of the MET varied substantially (median 20%; inter-quartile range [IQR]: 3.4%-29.8%; range: 0%-36.4%). Among patients who did not have a MET called prior to their IHCA, 78/141 (55.3%) had at least one abnormal vital sign that should have triggered a MET. Conclusion: In a large, national registry, we found that the majority of pediatric IHCA cases are not preceded by a MET evaluation despite meeting criteria that should have triggered a MET. Improved utilization of the MET by all hospitals could lead to fewer pediatric IHCA and improved outcomes following pediatric IHCA.

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

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&lt;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.

scholarly journals Predicting Medical Emergency Team Calls, Cardiac Arrest Calls and Re-Admission after Intensive Care Discharge: Creation of a Tool to Identify At-Risk Patients

2018 ◽  
Vol 46 (1) ◽  
pp. 88-96 ◽  
Author(s):  
Y. H. Ng ◽  
D. V. Pilcher ◽  
M. Bailey ◽  
C. A. Bain ◽  
C. MacManus ◽  
...  
Keyword(s):  
At Risk ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Predictive Model ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Multivariable Logistic Regression Analysis ◽  
Emergency Team ◽  
Icu Discharge ◽  
Patients At Risk

We aimed to develop a predictive model for intensive care unit (ICU)–discharged patients at risk of post-ICU deterioration. We performed a retrospective, single-centre cohort observational study by linking the hospital admission, patient pathology, ICU, and medical emergency team (MET) databases. All patients discharged from the Alfred Hospital ICU to wards between July 2012 and June 2014 were included. The primary outcome was a composite endpoint of any MET call, cardiac arrest call or ICU re-admission. Multivariable logistic regression analysis was used to identify predictors of outcome and develop a risk-stratification model. Four thousand, six hundred and thirty-two patients were included in the study. Of these, 878 (19%) patients had a MET call, 51 (1.1%) patients had cardiac arrest calls, 304 (6.5%) were re-admitted to ICU during the same hospital stay, and 964 (21%) had MET calls, cardiac arrest calls or ICU re-admission. A discriminatory predictive model was developed (area under the receiver operating characteristic curve 0.72 [95% confidence intervals {CI} 0.70 to 0.73]) which identified the following factors: increasing age (odds ratio [OR] 1.012 [95% CI 1.007 to 1.017] P <0.001), ICU admission with subarachnoid haemorrhage (OR 2.26 [95% CI 1.22 to 4.16] P=0.009), admission to ICU from a ward (OR 1.67 [95% CI 1.31 to 2.13] P <0.001), Acute Physiology and Chronic Health Evaluation (APACHE) III score without the age component (OR 1.005 [95% CI 1.001 to 1.010] P=0.025), tracheostomy on ICU discharge (OR 4.32 [95% CI 2.9 to 6.42] P <0.001) and discharge to cardiothoracic (OR 2.43 [95%CI 1.49 to 3.96] P <0.001) or oncology wards (OR 2.27 [95% CI 1.05 to 4.89] P=0.036). Over the two-year period, 361 patients were identified as having a greater than 50% chance of having post-ICU deterioration. Factors are identifiable to predict patients at risk of post-ICU deterioration. This knowledge could be used to guide patient follow-up after ICU discharge, optimise healthcare resources, and improve patient outcomes and service delivery.

Abstract 11: Medical Emergency Teams Reduce Unexpected Cardiac Arrests, But Not Overall Hospital Costs Per Case

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Harish Manyam ◽  
Michael S Cratty
Keyword(s):  
Cardiac Arrest ◽  
Hospital Cost ◽  
Medical Emergency Team ◽  
Hospital Costs ◽  
Medical Emergency ◽  
Total Cost ◽  
Emergency Team ◽  
Medical Emergency Teams ◽  
Group 2 ◽  
Group 1

Introduction : Medical emergency teams (MET) have been developed to meet the growing needs of hospitalized patients. Medical emergency teams have been shown to reduce unexpected cardiac arrests, unexpected ICU transfers, length of stay (LOS), and inpatient mortality. However, there is no data on overall hospital cost per case with the addition of a MET team. Hypothesis : We hypothesized that the addition of a MET to our hospital would reduce our hospital cost per case by reducing unexpected cardiac arrest. Methods : A MET was developed at our 714-bed teaching hospital in March 2006. Our goal was to perform a retrospective analysis of hospital costs per case related to cardiac arrest and MET responses before and after establishment of a MET team. The first comparison group included unexpected cardiac arrests for a 6-month period from March 2005-September 2005 before establishment of the MET team. The second group included unexpected cardiac arrest patients and patients seen by the MET team that required unexpected transfer to the ICU for a similar 6-month period from March 2006-September 2006 after development of the MET team. Results : Group 1 from 2005 included 76 unexpected cardiac arrest patients and Group 2 from 2006 included 48 unexpected cardiac arrests and 95 unexpected transfers to the ICU. Both groups had similar overall severity scores of 1.7. Overall we had a 37% reduction in unexpected cardiac arrests in the first 6 months after initiation of the MET team. The overall mean LOS was lower in group 2 at 15 days compared to 17 days in group 1, however there was no statistical significance (p=0.59). There was no difference in the mean total cost per case in group 2, $34,653± $32,500 compared to group 1, $37,657± $38,517 (p=0.58). Conclusion : The implementation of the medical emergency team at our hospital decreased unexpected cardiac arrests, but did not decrease mean total cost per case for patients suffering unexpected cardiac arrests and unexpected ICU transfer during activation of the medical emergency team.

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