scholarly journals Automated alert and activation of medical emergency team using early warning score

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Soo Jin Na ◽  
Ryoung-Eun Ko ◽  
Myeong Gyun Ko ◽  
Kyeongman Jeon
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Medical Emergency Team ◽  
Early Warning Score ◽  
Medical Emergency ◽  
Alert System ◽  
Primary Analysis ◽  
Emergency Team ◽  
Activation System ◽  
Implementation Period

Abstract Background Timely recognition of warning signs from deteriorating patients and proper treatment are important in improving patient safety. In comparison to the traditional medical emergency team (MET) activation triggered by phone calls, automated activation of MET may minimize activation delays. However, limited data are available on the effects of automated activation systems on the time from derangement to MET activation and on clinical outcomes. The objective of this study was to determine the impact of an automated alert and activation system for MET on clinical outcomes in unselected hospitalized patients. Methods This is an observational study using prospectively collected data from consecutive patients managed by the MET at a university-affiliated, tertiary hospital from March 2013 to December 2019. The automated alert system automatically calculates the Modified Early Warning Score (MEWS) and subsequently activates MET when the MEWS score is 7 or higher, which was implemented since August 2016. The outcome measures of interest including hospital mortality in patients with MEWS of 7 or higher were compared between pre-implementation and post-implementation groups of the automated alert and activation system in the primary analysis. The association between the implementation of the system and hospital mortality was evaluated with logistic regression analysis. Results Of the 7678 patients who were managed by MET during the study period, 639 patients during the pre-implementation period and 957 patients during the post-implementation period were included in the primary analysis. MET calls due to abnormal physiological variables were more common during the pre-implementation period, while MET calls due to medical staff’s worries or concern about the patient’s condition were more common during the post-implementation period. The median time from deterioration to MET activation was significantly shortened in the post-implementation period compared to the pre-implementation period (34 min vs. 60 min, P < 0.001). In addition, unplanned ICU admission rates (41.2% vs. 71.8%, P < 0.001) was reduced during the post-implementation period. Hospital mortality was decreased after implementation of the automated alert system (27.2% vs. 38.5%, P < 0.001). The implementation of the automated alert and activation system was associated with decreased risk of death in the multivariable analysis (adjusted OR 0.73, 95% CI 0.56–0.90). Conclusions After implementing an automated alert and activation system, the time from deterioration to MET activation was shortened and clinical outcomes were improved in hospitalized patients.

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.

scholarly journals Analysis of Origins of Admission for Solid Tumor Oncology Inpatients: Disease Severity and Outcomes

2017 ◽  
Vol 13 (7) ◽  
pp. e666-e672
Author(s):  
Christopher E. Wee ◽  
Lindsey M. Goodman ◽  
Leticia Varella ◽  
Lisa A. Rybicki ◽  
Alberto J. Montero ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Disease Severity ◽  
Solid Tumor ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Provider Type ◽  
Main Campus ◽  
Emergency Team ◽  
Risk Of Mortality ◽  
Time Of Admission

Purpose: Hospital transfers may affect clinical outcomes. Evaluation of admission by source of transfer, time of admission, and provider type may identify opportunities to improve inpatient outcomes. Methods: We reviewed charts of patients admitted to the solid tumor oncology service between July and December 2014 from the Cleveland Clinic Foundation (CCF) Main Campus emergency department (ED), CCF Regional EDs, outside hospital (OSH) ED, OSH inpatient services, and CCF outpatient clinics. Data collected included time of admission, mortality and severity risk scores, and provider type. Risk factors were assessed for clinical outcomes, including activations of the Adult Medical Emergency Team, intensive care unit transfers, in-hospital mortality, and length of stay (LOS). Results: Five hundred admissions were included. OSH inpatient transfers had significantly higher disease severity compared with all other origins of admission. OSH inpatient transfers demonstrated significantly longer LOS compared with all other origins of admission, and higher mortality rates compared with the outpatient direct admits and CCF Main Campus ED admits. After adjusting for disease severity and risk of mortality, OSH ED patients remained at higher risk for Adult Medical Emergency Team activation, OSH inpatient transfers had the longest LOS, and CCF Main Campus ED patients had the lowest risk of mortality. Time of admission and provider type were not associated with any of the outcomes. Conclusion: Oncology inpatients transferred from an outside health care facility are at higher risk for adverse outcomes. The magnitude of difference is lessened, but still significant, after adjustment for disease severity and risk of mortality.

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.

Medical emergency team activation: performance of conventional dichotomised criteria versus national early warning score

2014 ◽  
Vol 58 (4) ◽  
pp. 411-419 ◽  
Author(s):  
JOONAS TIRKKONEN ◽  
KLAUS T. OLKKOLA ◽  
HEINI HUHTALA ◽  
JYRKI TENHUNEN ◽  
SANNA HOPPU
Keyword(s):  
Early Warning ◽  
Medical Emergency Team ◽  
Early Warning Score ◽  
Medical Emergency ◽  
Emergency Team ◽  
National Early Warning Score

The critical care continuum

2017 ◽  
Author(s):  
Sheila Adam ◽  
Sue Osborne ◽  
John Welch
Keyword(s):  
Critical Care ◽  
Early Recognition ◽  
Medical Emergency Team ◽  
Kidney Injury ◽  
Organ Damage ◽  
Early Warning Score ◽  
Medical Emergency ◽  
Emergency Team ◽  
Critical Care Admission ◽  
The Impact

This chapter provides an overview of the development and expansion of critical care, to include early intervention and enhancement of recovery. This is based on the patient’s acuity and need for intervention rather than their location. It includes early recognition of, and response to, acute deterioration in patients in order to prevent irreversible organ damage or death. The use of tools such as the National Early Warning Score (NEWS) to identify these patients is described. The chapter covers the critical care outreach and medical emergency team concepts, as well as surviving sepsis and avoiding acute kidney injury initiatives. Peri-operative optimization to mitigate the impact of surgery and the need to follow up patients post-critical care admission to enhance recovery and prevent re-admission are also included.

Effects of admission (adm) source, time, and provider on inpatient (inpt) oncology (onc) outcomes at the Cleveland Clinic Foundation (CCF).

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 140-140
Author(s):  
Wee Christopher ◽  
Lindsey Martin Goodman ◽  
Lisa A. Rybicki ◽  
Alberto J. Montero ◽  
Bassam N. Estfan ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Tertiary Care ◽  
Medical Emergency Team ◽  
Cleveland Clinic ◽  
Healthcare Setting ◽  
Cleveland Clinic Foundation ◽  
Adverse Outcomes ◽  
Medical Emergency ◽  
Provider Type ◽  
Emergency Team

140 Background: The quality of care transfers is known to influence clinical outcomes. In an inpt onc setting at a major tertiary care referral center, patient (pt) adm originate from many different areas and times. A detailed evaluation of onc adm by source of transfer, admission time, and provider type, may identify opportunities to improve inpt clinical outcomes. Methods: We retrospectively reviewed all adm to the inpt solid tumor onc service from July - December 2014 from CCF regional hospital emergency departments (ED), outside hospital (OSH) ED, OSH inpt services, and CCF outpt clinics. Pts were excluded if the adm was planned or if admitted from the CCF Main Campus ED. Data collected included pt and encounter characteristics and provider type (house-staff or nocturnal hospitalist). Clinical outcomes, including activation of the adult medical emergency team (AMET), ICU transfers, length of stay (LOS), and in-hospital mortality were compared using chi-squared test; ECOG PS and LOS with the Kruskal-Wallis tests and Wilcoxon rank sum test. Results: A total of 413 unique pt admissions were reviewed. 213 were included after exclusion criteria were applied. The probability of AMET activation, mortality, and LOS differed by origin of transfer. Pts admitted from CCF regional EDs had the lowest median LOS and no deaths. OSH int transfers demonstrated significantly higher mortality vs other origins of transfer. Pts whose first orders were placed after 5pm had no significant differences in AMET activation, ICU transfers, LOS, or mortality vs daytime adm. There were no differences in adverse outcomes by the type of admitting provider. Conclusions: Onc inpts transferred from an outside healthcare setting were at highest risk for adverse outcomes (AMETs, increased LOS, and mortality) include those originating from OSH inpt services. Process and communication interventions focused on transfers from outside inpt facilities may improve safety and outcomes in this population. [Table: see text]

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