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

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.

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A Comparison of the Ability of the Physiologic Components of Medical Emergency Team Criteria and the U.K. National Early Warning Score to Discriminate Patients at Risk of a Range of Adverse Clinical Outcomes*

Critical Care Medicine ◽

10.1097/ccm.0000000000002000 ◽

2016 ◽

Vol 44 (12) ◽

pp. 2171-2181 ◽

Cited By ~ 30

Author(s):

Gary B. Smith ◽

David R. Prytherch ◽

Stuart Jarvis ◽

Caroline Kovacs ◽

Paul Meredith ◽

...

Keyword(s):

At Risk ◽

Clinical Outcomes ◽

Early Warning ◽

Medical Emergency Team ◽

Early Warning Score ◽

Medical Emergency ◽

Emergency Team ◽

Patients At Risk ◽

National Early Warning Score

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Features of an Intensive Care based Medical Emergency Team nurse training program in a University Teaching Hospital

Australian Critical Care ◽

10.1016/j.aucc.2015.03.001 ◽

2016 ◽

Vol 29 (1) ◽

pp. 46-49 ◽

Cited By ~ 5

Author(s):

Michelle Topple ◽

Brooke Ryan ◽

Richard McKay ◽

Damien Blythe ◽

John Rogan ◽

...

Keyword(s):

Intensive Care ◽

Training Program ◽

Teaching Hospital ◽

Medical Emergency Team ◽

University Teaching ◽

Medical Emergency ◽

Nurse Training ◽

Emergency Team

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Rates of in‐hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team

The Medical Journal of Australia ◽

10.5694/j.1326-5377.2000.tb125627.x ◽

2000 ◽

Vol 173 (5) ◽

pp. 236-240 ◽

Cited By ~ 223

Author(s):

Peter J Bristow ◽

Ken M HIiiman ◽

Kathy Daffum ◽

Sandra L Norman ◽

Gillian F Bishop ◽

...

Keyword(s):

Intensive Care ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team

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The Medical Emergency Team

Anaesthesia and Intensive Care ◽

10.1177/0310057x9502300210 ◽

1995 ◽

Vol 23 (2) ◽

pp. 183-186 ◽

Cited By ~ 382

Author(s):

A. Lee ◽

G. Bishop ◽

K. M. Hillman ◽

K. Daffurn

Keyword(s):

Cardiopulmonary Arrest ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team ◽

Patients At Risk ◽

Medical Emergencies ◽

One Year ◽

Seriously Ill Patients ◽

Team Interventions ◽

Seriously Ill

The concept of a Medical Emergency Team was developed in order to rapidly identify and manage seriously ill patients at risk of cardiopulmonary arrest and other high-risk conditions. The aim of this study was to describe the utilization and outcome of Medical Emergency Team interventions over a one-year period at a teaching hospital in South Western Sydney. Data was collected prospectively using a standardized form. Cardiopulmonary resuscitation occurred in 148/522 (28%) calls. Alerting the team using the specific condition criteria occurred in 253/522 (48%) calls and on physiological/pathological abnormality criteria in 121/522 (23%) calls. Survival rate to hospital discharge following cardiopulmonary arrest was low (29%), compared with other medical emergencies (76%).

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

Resuscitation ◽

10.1016/s0300-9572(02)00100-4 ◽

2002 ◽

Vol 54 (2) ◽

pp. 125-131 ◽

Cited By ~ 223

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

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Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit*

Pediatric Critical Care Medicine ◽

10.1097/01.pcc.0000262947.72442.ea ◽

2007 ◽

Vol 8 (3) ◽

pp. 236-246 ◽

Cited By ~ 141

Author(s):

Richard J. Brilli ◽

Rosemary Gibson ◽

Joseph W. Luria ◽

T Arthur Wheeler ◽

Julie Shaw ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Teaching Hospital ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team

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Outcome among patients suffering from in-hospital cardiac arrest

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1404170t ◽

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.

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Is postoperative intensive care unit admission a prerequisite for elective craniotomy?

Journal of Neurosurgery ◽

10.3171/2011.8.jns11105 ◽

2011 ◽

Vol 115 (6) ◽

pp. 1236-1241 ◽

Cited By ~ 43

Author(s):

John Q. H. Bui ◽

Rajith L. Mendis ◽

James M. van Gelder ◽

Mark M. P. Sheridan ◽

Kylie M. Wright ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Loss ◽

Medical Emergency Team ◽

Medical Emergency ◽

Safe Alternative ◽

Emergency Team ◽

Icu Admission ◽

Postoperative Intensive Care ◽

Postoperative Intensive Care Unit

Object Routine postoperative admission to the intensive care unit (ICU) is often considered a necessity in the treatment of patients following elective craniotomy but may strain already limited resources and is of unproven benefit. In this study the authors investigated whether routine postoperative admission to a regular stepdown ward is a safe alternative. Methods Three hundred ninety-four consecutive patients who had undergone elective craniotomy over 54 months at a single institution were retrospectively analyzed. Indications for craniotomy included tumor (257 patients) and transsphenoidal (63 patients), vascular (31 patients), ventriculostomy (22 patients), developmental (13 patients), and base of skull conditions (8 patients). Recorded data included age, operation, reason for ICU admission, medical emergency team (MET) calls, in-hospital mortality, and postoperative duration of stay. Results Three hundred forty-three patients were admitted to the regular ward after elective craniotomy, whereas there were 43 planned and 8 unplanned ICU admissions. The most common reasons for planned ICU admissions were anticipated lengthy operations (42%) and anesthetic risks (40%); causes for unplanned ICU admissions were mainly unexpected slow neurological recovery and extensive intraoperative blood loss. Of the 343 regular ward admissions, 10 (3%) required a MET call; only 3 of these MET calls occurred within the first 48 postoperative hours and did not lead to an ICU admission. The overall mortality rate in the investigated cohort was 1%, with no fatalities in patients admitted to the normal ward postoperatively. Conclusions Routine ward admission for patients undergoing elective craniotomies with selective ICU admission appears safe; however, approximately 2% of patients may require a direct postoperative unplanned ICU admission. Patients with anticipated long operation times, extensive blood loss, and high anesthetic risks should be selected for postoperative ICU admission, but further study is needed to determine the preoperative factors that can aid in identifying and caring for these groups of patients.

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

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.220 ◽

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.

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