scholarly journals A point-of-care thoracic ultrasound protocol for hospital medical emergency teams (METUS) improves diagnostic accuracy

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Blans M.J ◽  
Bousie E ◽  
Hoeven van der J.G ◽  
Bosch F.H
Keyword(s):  
Point Of Care ◽  
Correct Diagnosis ◽  
Medical Emergency Team ◽  
Final Diagnosis ◽  
Medical Emergency ◽  
Point Of Care Ultrasound ◽  
Emergency Team ◽  
Medical Emergency Teams ◽  
The Us ◽  
Few Data

Abstract Background Point-of-care ultrasound (POCUS) has proven itself in many clinical situations. Few data on the use of POCUS during Medical Emergency Team (MET) calls exist. In this study, we hypothesized that the use of POCUS would increase the number of correct diagnosis made by the MET and increase MET’s certainty. Methods Single-center prospective observational study on adult patients in need for MET assistance. Patients were included in blocks (weeks). During even weeks, the MET physician performed a clinical assessment and registered an initial diagnosis. Subsequently, the POCUS protocol was performed and a second diagnosis was registered (US+). During uneven weeks, no POCUS was performed (US−). A blinded expert reviewed the charts for a final diagnosis. The number of correct diagnoses was compared to the final diagnosis between both groups. Physician’s certainty, mortality and possible differences in first treatment were also evaluated. Results We included 100 patients: 52 in the US + and 48 in the US−  group. There were significantly more correct diagnoses in the US+ group compared to the US− group: 78 vs 51% (P  = 0.006). Certainty improved significantly with POCUS (P  <  0.001). No differences in 28-day mortality and first treatment were found. Conclusions The use of thoracic POCUS during MET calls leads to better diagnosis and increases certainty. Trial registration. ClinicalTrials.gov. Registered 12 July 2017, NCT03214809 https://www.clinicaltrials.gov/ct2/show/NCT03214809?term=metus&cntry=NL&draw=2&rank=1

scholarly journals Triggers and Interventions of Patients Who Require Medical Emergency Team Reviews: A Cross-Sectional Analysis of Single Versus Multiple Reviews

2021 ◽  
Vol 41 (4) ◽  
pp. e1-e10
Author(s):  
Gobnait Byrne ◽  
Shauna Ennis ◽  
Anne Marie Barnes ◽  
Patricia Morrison ◽  
Siobhan Connors ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Demographic Data ◽  
Medical Emergency Team ◽  
Clinical Decision ◽  
Early Warning Systems ◽  
Surgical Patients ◽  
Medical Emergency ◽  
Cross Sectional ◽  
Emergency Team ◽  
Medical Emergency Teams

Background Medical emergency teams constitute part of the escalation protocol of early warning systems in many hospitals. The literature indicates that medical emergency teams may reduce hospital mortality and cardiac arrest. A greater understanding of pathways of patients who experience multiple medical emergency team reviews will inform clinical decision-making. Objectives To explore differences between patients who require a single medical emergency team review and those who require multiple reviews, and to identify any differences between patients who were reviewed only once during admission and patients who required multiple reviews. Methods Data for this retrospective cross-sectional review, including demographic data, call triggers, outcomes, and interventions, were routinely collected from January 2013 through December 2015. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) collaborative’s cross-sectional studies checklist (version 4). Results Of 54 787 admitted patients, 1274 (2%) required a call to a medical emergency team; of those, 260 patients (20%) needed multiple calls. Patients requiring multiple calls demonstrated higher mortality (odds ratio, 1.49 [95% CI, 1.12–1.98]). A logistic regression model identified surgical patients and those receiving antibiotics and respiratory interventions at the first medical emergency team review as being more likely to require multiple reviews. Patients transferred to a higher level of care after the first review were less likely to require another review. Conclusions Patients requiring multiple medical emergency team reviews have higher mortality. Surgical patients have a higher risk of requiring multiple reviews. Hospitals need to include more details on surgical patients when auditing medical emergency team activation.

scholarly journals Automated detection of physiologic deterioration in hospitalized patients

2014 ◽  
Vol 22 (2) ◽  
pp. 350-360 ◽  
Author(s):  
R Scott Evans ◽  
Kathryn G Kuttler ◽  
Kathy J Simpson ◽  
Stephen Howe ◽  
Peter F Crossno ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Point Of Care ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Surgical Trauma ◽  
Emergency Team ◽  
Charge Nurses ◽  
Large Level ◽  
Level 1 ◽  
Level 1 Trauma Center

Abstract Objective Develop and evaluate an automated case detection and response triggering system to monitor patients every 5 min and identify early signs of physiologic deterioration. Materials and methods A 2-year prospective, observational study at a large level 1 trauma center. All patients admitted to a 33-bed medical and oncology floor (A) and a 33-bed non-intensive care unit (ICU) surgical trauma floor (B) were monitored. During the intervention year, pager alerts of early physiologic deterioration were automatically sent to charge nurses along with access to a graphical point-of-care web page to facilitate patient evaluation. Results Nurses reported the positive predictive value of alerts was 91–100% depending on erroneous data presence. Unit A patients were significantly older and had significantly more comorbidities than unit B patients. During the intervention year, unit A patients had a significant increase in length of stay, more transfers to ICU (p = 0.23), and significantly more medical emergency team (MET) calls (p = 0.0008), and significantly fewer died (p = 0.044) compared to the pre-intervention year. No significant differences were found on unit B. Conclusions We monitored patients every 5 min and provided automated pages of early physiologic deterioration. This before–after study found a significant increase in MET calls and a significant decrease in mortality only in the unit with older patients with multiple comorbidities, and thus further study is warranted to detect potential confounding. Moreover, nurses reported the graphical alerts provided information needed to quickly evaluate patients, and they felt more confident about their assessment and more comfortable requesting help.

scholarly journals Observational cohort study of the triggers, diagnoses and outcomes of the medical emergency team (MET) response in adult psychiatry inpatients colocated with acute medical services in Australia

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e046110
Author(s):  
Meor Azraai ◽  
Jeanette H Pham ◽  
Wenye F Looi ◽  
Daniel Wirth ◽  
Ashley S L Ng ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Effects ◽  
Medical Emergency Team ◽  
Final Diagnosis ◽  
Medical Emergency ◽  
Medical Services ◽  
Secondary Outcome ◽  
Emergency Team ◽  
Risk Of Death ◽  
Drug Adverse Effects

ObjectivesMedical emergencies in psychiatric inpatients are challenging due to the model of care and limited medical resources. The study aims were to determine the triggers and outcomes of a medical emergency team (MET) call in psychiatric wards, and the risk factors for MET activation and mortality.DesignRetrospective multisite cohort study.SettingPsychiatry units colocated with acute medical services at three major metropolitan hospitals in Melbourne, Australia.ParticipantsWe studied 487 adult inpatients who experienced a total of 721 MET calls between January 2015 and January 2020. Patients were relatively young (mean age, 45 years) and had few medical comorbidities, but a high prevalence of smoking, excessive alcohol intake and illicit drug use.Outcome measuresWe performed a descriptive analysis of the triggers and outcomes (transfer rates, investigations, final diagnosis) of MET calls. We used logistic regression to determine the factors associated with the primary outcome of inpatient mortality, and the secondary outcome of the need for specific medical treatment compared with simple observation.ResultsThe most common MET triggers were a reduced Glasgow Coma Scale, tachycardia and hypotension, and 49% of patients required transfer. The most frequent diagnosis was a drug adverse effect or toxidrome, followed by infection and dehydration. There was a strong association between a leave of absence and MET calls, tachycardia and the final diagnosis of drug adverse effects. Mortality occurred in 3% after MET calls. Several baseline and MET clinical variables were associated with mortality but a model with age (per 10 years, OR 1.61, 95% CI 1.29 to 2.01) and hypoxia (OR 3.59, 95% CI 1.43 to 9.04) independently predicted mortality.ConclusionVigilance is required in patients returning from day leave, and drug adverse effects remain a challenging problem in psychiatric units. Hypoxic older patients with cardiovascular comorbidity have a higher risk of death.

Point-of-care testing during medical emergency team activations: A pilot study

Resuscitation ◽  
2012 ◽  
Vol 83 (9) ◽  
pp. 1119-1123 ◽  
Author(s):  
P. Calzavacca ◽  
E. Licari ◽  
A. Tee ◽  
R. Bellomo
Keyword(s):  
Pilot Study ◽  
Point Of Care ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Point Of Care Testing ◽  
Emergency Team

Randomized Controlled Trial of Point-of-Care Ultrasound Education for the Recognition of Tension Pneumothorax by Paramedics in Prehospital Simulation

2020 ◽  
pp. 1-5
Author(s):  
Paul A. Khalil ◽  
Andrew Merelman ◽  
John Riccio ◽  
Jodi Peterson ◽  
Ryan Shelton ◽  
...  
Keyword(s):  
Point Of Care ◽  
Controlled Trial ◽  
Correct Diagnosis ◽  
Intervention Group ◽  
Tension Pneumothorax ◽  
Control Group ◽  
Point Of Care Ultrasound ◽  
Randomized Controlled ◽  
The Us ◽  
Us Intervention

Abstract Objective: The primary goal of this study was to determine if ultrasound (US) use after brief point-of-care ultrasound (POCUS) training on cardiac and lung exams would result in more paramedics correctly identifying a tension pneumothorax (TPTX) during a simulation scenario. Methods: A randomized controlled, simulation-based trial of POCUS lung exam education investigating the ability of paramedics to correctly diagnose TPTX was performed. The US intervention group received a 30-minute cardiac and lung POCUS lecture followed by hands-on US training. The control group did not receive any POCUS training. Both groups participated in two scenarios: right unilateral TPTX and undifferentiated shock (no TPTX). In both scenarios, the patient continued to be hypoxemic after verified intubation with pulse oximetry of 86%-88% and hypotensive with a blood pressure of 70/50. Sirens were played at 65 decibels to mimic prehospital transport conditions. A simulation educator stated aloud the time diagnoses were made and procedures performed, which were recorded by the study investigator. Paramedics completed a pre-survey and post-survey. Results: Thirty paramedics were randomized to the control group; 30 paramedics were randomized to the US intervention group. Most paramedics had not received prior US training, had not previously performed a POCUS exam, and were uncomfortable with POCUS. Point-of-care US use was significantly higher in the US intervention group for both simulation cases (P <.001). A higher percentage of paramedics in the US intervention group arrived at the correct diagnosis (77%) for the TPTX case as compared to the control group (57%), although this difference was not significantly different (P = 0.1). There was no difference in the correct diagnosis between the control and US intervention groups for the undifferentiated shock case. On the post-survey, more paramedics in the US intervention group were comfortable with POCUS for evaluation of the lung and comfortable decompressing TPTX using POCUS (P <.001). Paramedics reported POCUS was within their scope of practice. Conclusions: Despite being novice POCUS users, the paramedics were more likely to correctly diagnose TPTX during simulation after a brief POCUS educational intervention. However, this difference was not statistically significant. Paramedics were comfortable using POCUS and felt its use improved their TPTX diagnostic skills.

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.

scholarly journals High Rate of Medical Emergency Team Activation in Children with Tracheostomy

2019 ◽  
Vol 09 (01) ◽  
pp. 027-033
Author(s):  
Brianna L. McKelvie ◽  
Anna-Theresa Lobos ◽  
Jason Chan ◽  
Franco Momoli ◽  
James Dayre McNally
Keyword(s):  
High Risk ◽  
Medical Emergency Team ◽  
General Ward ◽  
High Rate ◽  
Medical Emergency ◽  
Emergency Team ◽  
Activation Rate ◽  
Medical Emergency Teams ◽  
Risk Patients ◽  
Activation Rates

AbstractPediatric in-patients with tracheostomy (PIT) are at high risk for clinical deterioration. Medical emergency teams (MET) have been developed to identify high-risk patients. This study compared MET activation rates between PITs and the general ward population. This was a retrospective cohort study conducted at a tertiary pediatric hospital. The primary outcome (MET activation) was obtained from a database. Between 2008 and 2014, the MET activation rate was significantly higher in the PIT group than the general ward population (14 vs. 2.9 per 100 admissions, p < 0.001). PITs are at significantly higher risk for MET activation. Strategies should be developed to reduce their risk on the wards.

Usefulness of point-of-care ultrasound in military medical emergencies performed by young military medicine residents

2019 ◽  
pp. jramc-2018-001132
Author(s):  
Pierre Perrier ◽  
J Leyral ◽  
O Thabouillot ◽  
D Papeix ◽  
G Comat ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Examination ◽  
Point Of Care ◽  
Military Medicine ◽  
Final Diagnosis ◽  
Absolute Difference ◽  
Point Of Care Ultrasound ◽  
Medical Emergencies ◽  
The Mean ◽  
A Prospective Study

IntroductionTo evaluate the usefulness of point-of-care ultrasound (POCUS) performed by young military medicine residents after short training in the diagnosis of medical emergencies.MethodsA prospective study was performed in the emergency department of a French army teaching hospital. Two young military medicine residents received ultrasound training focused on gall bladder, kidneys and lower limb veins. After clinical examination, they assigned a ‘clinicaldiagnostic probability’ (CP) on a visual analogue scale from 0 (definitely not diagnosis) to 10 (definitive diagnosis). The same student performed ultrasound examination and assigned an ‘ultrasounddiagnostic probability’ (UP) in the same way. The absolute difference between CP and UP was calculated. This result corresponded to the Ultrasound Diagnostic Index (UDI), which was positive if UP was closer to the final diagnosis than CP (POCUS improved the diagnostic accuracy), and negative conversely (POCUS decreased the diagnostic accuracy).ResultsForty-eight patients were included and 48 ultrasound examinations were performed. The present pathologies were found in 14 patients (29%). The mean UDI value was +3 (0–5). UDI was positive in 35 exams (73%), zero in 12 exams (25%) and negative in only one exam (2%).ConclusionPOCUS performed after clinical examination increases the diagnostic accuracy of young military medicine residents.

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