Abstract 346: Cardiac Diagnoses and Initial Presentation to the Emergency Department May Be Associated With Hospital Mortality Among Hospitalized Pediatric Patients Who Experience Medical Emergency Team Events

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Rebecca J Piasecki ◽  
Mona N Bahouth ◽  
Chakra Budhathoki ◽  
Heather M Newton ◽  
Jordan M Duval-Arnould ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hospital Mortality ◽  
Pediatric Patients ◽  
Medical Emergency Team ◽  
Patient Characteristics ◽  
Medical Emergency ◽  
Admission Diagnosis ◽  
Emergency Department Care ◽  
Emergency Team ◽  
Levels Of Care

Introduction: There is a paucity of data regarding the association of pediatric patient characteristics with hospital mortality and transfer to higher levels of care following medical emergency team (MET) events. Objective: To explore associations of patient characteristics with hospital mortality and transfer to higher levels of care among pediatric patients who experienced a MET event during an admission. Methods: This retrospective observational study included data from patients aged ≤17 years admitted to an urban, tertiary hospital who experienced a MET event between 2014 and 2017. Data specific to the initial MET event for a patient were included for analysis. Multiple logistic regression models were used to test associations between patient characteristics (age, race, sex, ethnicity, timing of MET event, primary admission diagnosis, receiving care on specialized units) and each outcome separately. Results: Of the 366 patients eligible for inclusion, 11% (41 of 366) experienced hospital mortality, and 59% (216 of 366) were transferred to higher levels of care following MET events. Hospital mortality was lower among those who received emergency department care within 24 hours before the MET event compared to patients who did not (OR=0.17; 95% CI=0.04-0.82). Hospital mortality was higher among those with cardiac-related primary admission diagnoses compared to patients with noncardiac-related diagnoses (OR=3.44; 95% CI=1.04-11.39), and among those of unknown race compared to white patients (OR=3.14; 95% CI=1.17-8.48). No patient characteristics were associated with transfers to higher levels of care. Conclusions: While MET events may cause concern about failures to triage patients to appropriate levels of care upon admission, we observed that patients admitted from the emergency department within 24 hours before their MET event were more likely to survive to discharge. Higher hospital mortality following MET events was observed among patients with cardiac diagnoses and those of unknown race; more research is needed to understand how processes and documentation of care are related to these patients. Further study of how these characteristics and other potential confounding factors are associated with MET events and outcomes is warranted.

Abstract 034: Rapid Response Activation and In-hospital Mortality

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Kinan Kassar ◽  
Dorothy Pusateri ◽  
Anastasios Kapetanos
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Respiratory Distress ◽  
Mental Status ◽  
Medical Emergency Team ◽  
Patient Characteristics ◽  
Rapid Response ◽  
Medical Emergency ◽  
Emergency Team ◽  
Healthcare Improvement

Introduction: The institute for Healthcare Improvement (IHI) encouraged the implementation of rapid response teams (RRT) in hospitals with the aim of early detection of patient deterioration. The rapid response system (formerly Medical Emergency Team (MET)) has been in place at our institution since 2005; however, data regarding its utilization and outcomes are scarce. Methods: Data regarding patient characteristics and reasons for activating RRTs were collected from hospital telephone operator records and patient medical records. The study was IRB exempt. Results: During a 2 month period (08/09/16 to 10/09/16), the RRT was activated 96 times on 93 patients. Of those, 31 RRT activations (32%) took place within 24 hours of admission to the hospital. The average age of these patients was 64, and 59% were male. Fifty-four RRT activations (56%) were called during the daytime shift (from 7 am to 7 pm). The reason for calling the RRT was mentioned in the hospital operators paging message in 67/96 cases. The most common reasons for activating the system were: Respiratory distress 34/67 (51%), mental status changes 9/67 (13%), and tachycardia 9/67 (13%). Other less common causes were seizures 3/67 (4.5%), chest pain 3/67 (4.5%), hypotension 3/67 (4.5%), and falls 2/67 (3%). Twenty patients (22%) on whom an RRT was called, died during the same hospital admission. The mortality rate of those patients was 6 folds higher than the general In-hospital mortality rate. The average age of the patients who died was 63. Respiratory distress was the most common cause of RRT activation among patients who died 10/20 (50%). Conclusion: Patients admitted to the hospital who had an RRT activation had a six fold risk of dying during the same admission. The majority of RRT activations were for respiratory distress, mental status changes, and tachycardia, and one-third occurred within the first 24 hours of admission. Routine review of RRT data can help target areas for improvement, specifically, factors contributing to in-hospital mortality.

scholarly journals The association between abnormal vital sign groups and undesirable patient outcomes

2018 ◽  
Vol 25 (3) ◽  
pp. 137-145
Author(s):  
Marina Lee ◽  
David McD Taylor ◽  
Antony Ugoni
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Patient Outcomes ◽  
Vital Sign ◽  
Odds Ratio ◽  
Medical Emergency Team ◽  
Vital Signs ◽  
Medical Emergency ◽  
Emergency Team ◽  
Abnormal Vital Sign

Introduction: To determine the association between both abnormal individual vital signs and abnormal vital sign groups in the emergency department, and undesirable patient outcomes: hospital admission, medical emergency team calls and death. Method: We undertook a prospective cohort study in a tertiary referral emergency department (February–May 2015). Vital signs were collected prospectively in the emergency department and undesirable outcomes from the medical records. The primary outcomes were undesirable outcomes for individual vital signs (multivariate logistic regression) and vital sign groups (univariate analyses). Results: Data from 1438 patients were analysed. Admission was associated with tachycardia, tachypnoea, fever, ≥1 abnormal vital sign on admission to the emergency department, ≥1 abnormal vital sign at any time in the emergency department, a persistently abnormal vital sign, and vital signs consistent with both sepsis (tachycardia/hypotension/abnormal temperature) and pneumonia (tachypnoea/fever) (p < 0.05). Medical emergency team calls were associated with tachycardia, tachypnoea, ≥1 abnormal vital sign on admission (odds ratio: 2.3, 95% confidence interval: 1.4–3.8), ≥2 abnormal vital signs at any time (odds ratio: 2.4, 95% confidence interval: 1.2–4.7), and a persistently abnormal vital sign (odds ratio: 2.7, 95% confidence interval: 1.6–4.6). Death was associated with Glasgow Coma Score ≤13 (odds ratio: 6.3, 95% confidence interval: 2.5–16.0), ≥1 abnormal vital sign on admission (odds ratio: 2.6, 95% confidence interval: 1.2–5.6), ≥2 abnormal vital signs at any time (odds ratio: 6.4, 95% confidence interval: 1.4–29.5), a persistently abnormal vital sign (odds ratio: 4.3, 95% confidence interval: 2.0–9.0), and vital signs consistent with pneumonia (odds ratio: 5.3, 95% confidence interval: 1.9–14.8). Conclusion: Abnormal vital sign groups are generally superior to individual vital signs in predicting undesirable outcomes. They could inform best practice management, emergency department disposition, and communication with the patient and family.

scholarly journals A physician-led medical emergency team increases the rate of medical interventions: A multicenter study in Korea

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258221
Author(s):  
Su Yeon Lee ◽  
Jee Hwan Ahn ◽  
Byung Ju Kang ◽  
Kyeongman Jeon ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Medical Emergency Team ◽  
Rapid Response ◽  
Medical Emergency ◽  
Arterial Line ◽  
Screening System ◽  
Emergency Team ◽  
Line Insertion ◽  
Icu Transfer ◽  
Portable Ultrasonography

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.

Increased Mortality and Length of Stay Associated With Medical Emergency Team Review in Hospitalized Pediatric Patients

2017 ◽  
Vol 18 (6) ◽  
pp. 571-579 ◽  
Author(s):  
Brianna McKelvie ◽  
James Dayre McNally ◽  
Jason Chan ◽  
Franco Momoli ◽  
Christa Ramsay ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Pediatric Patients ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Emergency Team

scholarly journals Impact of hospitalization duration before medical emergency team activation: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247066
Author(s):  
Jinmi Lee ◽  
Yujung Shin ◽  
Eunjoo Choi ◽  
Sunhui Choi ◽  
Jeongsuk Son ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Medical Center ◽  
Medical Emergency Team ◽  
Patient Characteristics ◽  
Medical Emergency ◽  
Emergency Team ◽  
Duration Of Hospitalization ◽  
Intensive Care Unit Transfer ◽  
General Wards ◽  
The Relationship

Background The rapid response system has been implemented in many hospitals worldwide and, reportedly, the timing of medical emergency team (MET) attendance in relation to the duration of hospitalization is associated with the mortality of MET patients. We evaluated the relationship between duration of hospitalization before MET activation and patient mortality. We compared cases of MET activation for early, intermediate, and late deterioration to patient characteristics, activation characteristics, and patient outcomes. We also aimed to determine the relationship, after adjusting for confounders, between the duration of hospitalization before MET activation and patient mortality. Materials and methods We retrospectively evaluated patients who triggered MET activation in general wards from March 2009 to February 2015 at the Asan Medical Center in Seoul. Patients were categorized as those with early deterioration (less than 2 days after admission), intermediate deterioration (2–7 days after admission), and late deterioration (more than 7 days after admission) and compared them to patient characteristics, activation characteristics, and patient outcomes. Results Overall, 7114 patients were included. Of these, 1793 (25.2%) showed early deterioration, 2113 (29.7%) showed intermediate deterioration, and 3208 (45.1%) showed late deterioration. Etiologies of MET activation were similar among these groups. The clinical outcomes significantly differed among the groups (intensive care unit transfer: 34.1%, 35.6%, and 40.4%; p < 0.001 and mortality: 26.3%, 31.5%, and 41.2%; p < 0.001 for early, intermediate, and late deterioration, respectively). Compared with early deterioration and adjusted for confounders, the odds ratio of mortality for late deterioration was 1.68 (1.46–1.93). Conclusions Nearly 50% of the acute clinically-deteriorating patients who activated the MET had been hospitalized for more than 7 days. Furthermore, they presented with higher rates of mortality and ICU transfer than patients admitted for less than 7 days before MET activation and had mortality as an independent risk factor.

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.

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