Association of Pediatric Medical Emergency Teams With Hospital Mortality

Abstract Objective Medical emergency teams (MET) are mostly led by physicians. Some hospitals are currently using nurse practitioners (NP) to lead MET calls. These are no studies comparing clinical outcomes between these two care models. To determine whether NP-led MET calls are associated with lower risk of acute patient deterioration, when compared to intensive care (ICU) registrar (ICUR)-led MET calls. Methods The composite primary outcome included recurrence of MET call, occurrence of code blue or ICU admission within 24 h. Secondary outcomes were mortality within 24 h of MET call, length of hospital stay, hospital mortality and proportion of patients discharged home. Propensity score matching was used to reduce selection bias from confounding factors between the ICUR and NP group. Results A total of 1343 MET calls were included (1070 NP, 273 ICUR led). On Univariable analysis, the incidence of the primary outcome was higher in ICUR-led MET calls (26.7% vs. 20.6%, p = 0.03). Of the secondary outcome measures, mortality within 24 h (3.4% vs. 7.7%, p = 0.002) and hospital mortality (12.7% vs. 20.5%, p = 0.001) were higher in ICUR-led MET calls. Propensity score-matched analysis of 263 pairs revealed the composite primary outcome was comparable between both groups, but NP-led group was associated with reduced risk of hospital mortality (OR 0.57, 95% CI 0.35–0.91, p = 0.02) and higher likelihood of discharge home (OR 1.55, 95% CI 1.09–2.2, p = 0.015). Conclusion Acute patient deterioration was comparable between ICUR- and NP-led MET calls. NP-led MET calls were associated with lower hospital mortality and higher likelihood of discharge home.

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Comparison of Cinical Outcomes Between Nurse Practitioner and Registrar led Medical Emergency Teams – A Propensity Matched Analysis.

10.21203/rs.3.rs-125418/v1 ◽

2020 ◽

Author(s):

Sachin Gupta ◽

Mayurathan Balachandran ◽

Gaby Bolton ◽

Naomi Pratt ◽

Jo Molloy ◽

...

Keyword(s):

Propensity Score ◽

Hospital Mortality ◽

Nurse Practitioners ◽

Primary Outcome ◽

Medical Emergency ◽

Secondary Outcome ◽

Patient Deterioration ◽

Discharge Home ◽

Medical Emergency Teams ◽

Acute Patient

Abstract Objective: Medical emergency teams (MET) are mostly led by physicians. Some hospitals are currently using nurse practitioners (NP) to lead MET calls. These are no studies comparing clinical outcomes between these two care models. To determine if NP led MET calls are associated with lower risk of acute patient deterioration, when compared to intensive care (ICU) registrar (ICUR) led MET calls.Methods: The composite primary outcome included recurrence of MET call, occurrence of Code blue or ICU admission within 24 hours. Secondary outcomes were mortality within 24 hours of MET call, length of hospital stay, hospital mortality and proportion of patients discharged home. Propensity score matching was used to reduce selection bias from confounding factors between the ICUR and NP group.Results: A total of 1343 MET calls were included (1070 NP, 273 ICUR led). On Univariable analysis, the incidence of the primary outcome was higher in ICUR led MET calls (26.7% vs 20.6%, p = 0.03). Of the secondary outcome measures, mortality within 24 hours (3.4% vs 7.7%, p = 0.002) and hospital mortality (12.7% vs 20.5%, p = 0.001) was higher in ICUR led MET calls. Propensity score matched analysis of 263 pairs revealed the composite primary outcome was comparable between both groups but NP led group was associated with reduced risk of hospital mortality (OR 0.57, 95%CI 0.35-0.91, p = 0.02) and higher likelihood of discharge home (OR 1.55, 95% CI 1.09-2.2, p=0.015). Conclusion: Acute patient deterioration was comparable between ICUR and NP led MET Calls. NP led MET calls were associated with lower hospital mortality and higher likelihood of discharge home.

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

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/bf03021506 ◽

2008 ◽

Vol 55 (4) ◽

pp. 223-231 ◽

Cited By ~ 49

Author(s):

Alan D. Baxter ◽

Pierre Cardinal ◽

Jonathan Hooper ◽

Rakesh Patel

Keyword(s):

Medical Emergency ◽

Ottawa Hospital ◽

Medical Emergency Teams

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Use of MitraClip system for severe mitral regurgitation in cardiogenic shock: results from a multicentre observational Italian experience (the MITRA-SHOCK study)

European Heart Journal ◽

10.1093/ehjci/ehaa946.2635 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Falasconi ◽

L Pannone ◽

F Melillo ◽

M Adamo ◽

F Ronco ◽

...

Keyword(s):

Mitral Regurgitation ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Therapeutic Option ◽

Strong Predictor ◽

Medical Emergency ◽

Short Term ◽

Italian Experience ◽

Procedural Success ◽

Mitraclip System

Abstract Background/Introduction Cardiogenic shock (CS) is a medical emergency and a frequent cause of death. CS can be complicated by mitral regurgitation (MR). The presence of at least moderate MR in the setting of shock was associated with about three-times higher odds of 1-year mortality. In the setting of refractory CS, percutaneous mitral valve repair (PMVR) can be a potential therapeutic option. Purpose The aim of the study was to evaluate the efficacy of percutaneous approach of severe MR in patients with CS assessing short-term clinical outcomes. Methods In this study we retrospectively included patients with CS and concomitant severe MR treated with Mitraclip system. We enrolled 28 patients from 5 Italian centers between 2012 and 2019. MitraClip implantation was performed according to each hospital standard care. CS was defined utilizing the Diagnostic Criteria of Cardiogenic Shock used in the SHOCK trial. Procedural success was defined as the presence of moderate or less MR after MitraClip implantation. Results All patients presented at least severe MR. All treated patients were at high surgical risk (STS mortality score 36.4±11.7%). Procedural success was obtained in 24 patients (86%). A mean of 1.71±0.76 clips per patients were implanted. In-hospital complications occurred in 13 patients (46%): 7 minor bleedings (25% of patients), 7 major bleedings (25%), 8 acute kidney injuries (28%). In-hospital mortality was 25% and the reported causes of death were cardiovascular in all patients. At Cox multivariate analysis procedural success was a strong predictor of in-hospital survival (HR 0.11, CI 95% 0.02–0.67, p=0.017). Conclusions PMVR with Mitraclip system in patients with CS and concomitant MR demonstrated high procedural success and acceptable safety. It can be considered a bailout option in this setting of patients with high short-term mortality. Larger prospective studies are needed. In-hospital mortality predictors Funding Acknowledgement Type of funding source: None

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Outcomes of Patients Treated with Prehospital Noninvasive Ventilation: Observational Retrospective Multicenter Study in the Northern French Alps

Journal of Clinical Medicine ◽

10.3390/jcm10071359 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1359

Author(s):

Julie Pinczon ◽

Nicolas Terzi ◽

Pascal Usseglio-Polatera ◽

Gaël Gheno ◽

Dominique Savary ◽

...

Keyword(s):

Noninvasive Ventilation ◽

Medical Emergency ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Acute Cardiogenic Pulmonary Edema ◽

Prehospital Management ◽

Medical Emergency Teams ◽

Prehospital Diagnosis ◽

Current Guidelines ◽

Retrospective Multicenter Study

Noninvasive ventilation (NIV) improves the outcome of acute cardiogenic pulmonary edema (AcPE) and acute exacerbation of chronic obstructive pulmonary disease (aeCOPD) but is not recommended in pneumonia. The aim of this study was to assess the appropriateness of the use of NIV in a prehospital setting, where etiological diagnostics rely mainly on clinical examination. This observational multicenter retrospective study included all the patients treated with NIV by three mobile medical emergency teams in 2015. Prehospital diagnoses and hospital diagnoses were extracted from the medical charts. The appropriateness of NIV was determined by matching the hospital diagnosis to the current guidelines. Among the 14,067 patients screened, 172 (1.2%) were treated with NIV. The more frequent prehospital diagnoses were AcPE (n = 102, 59%), acute respiratory failure of undetermined cause (n = 46, 28%) and aeCOPD (n = 17, 10%). An accurate prehospital diagnosis was more frequent for AcPE (83/88, 94%) than for aeCOPD (14/32, 44%; p < 0.01). Only two of the 25 (8%) pneumonia cases were diagnosed during prehospital management. Prehospital NIV was inappropriate for 32 (21%) patients. Patients with inappropriate NIV had a higher rate of in-hospital intubation than patients with appropriate NIV (38% vs. 8%; p < 0.001). This high frequency of inappropriate NIV could be reduced by an improvement in the prehospital detection of aeCOPD and pneumonia.

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Medical emergency teams: Are improved outcomes really like day and night?*

Critical Care Medicine ◽

10.1097/01.ccm.0000219369.59563.9a ◽

2006 ◽

Vol 34 (6) ◽

pp. 1840-1841

Author(s):

Jennifer Needle ◽

Michael R. Anderson

Keyword(s):

Medical Emergency ◽

Improved Outcomes ◽

Medical Emergency Teams

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In-situ simulation

Trauma ◽

10.1177/1460408617711729 ◽

2017 ◽

Vol 20 (4) ◽

pp. 281-288 ◽

Cited By ~ 2

Author(s):

Louise Schofield ◽

Emma Welfare ◽

Simon Mercer

Keyword(s):

Medical Emergency ◽

In Situ Simulation ◽

Advantages And Disadvantages ◽

Medical Emergency Teams ◽

Clinical Workplace ◽

Trauma Teams ◽

New Guidelines

‘In-situ’ simulation or simulation ‘in the original place’ is gaining popularity as an educational modality. This article discusses the advantages and disadvantages of performing simulation in the clinical workplace drawing on the authors’ experience, particularly for trauma teams and medical emergency teams. ‘In-situ’ simulation is a valuable tool for testing new guidelines and assessing for latent errors in the workplace.

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

PLoS ONE ◽

10.1371/journal.pone.0258221 ◽

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.

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