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

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.

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

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.140 ◽

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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Clinical Outcomes of patients triggering Medical Emergency Team calls for sinus tachycardia

Internal Medicine Journal ◽

10.1111/imj.15093 ◽

2020 ◽

Author(s):

Arunbalaji Muthusamy ◽

Ameera S Amiruddin ◽

Elizabeth S L Low ◽

Chamila D M Liyanage ◽

Blake P Mumford ◽

...

Keyword(s):

Clinical Outcomes ◽

Sinus Tachycardia ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team

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

Journal of Intensive Care ◽

10.1186/s40560-021-00588-y ◽

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.

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An exploration of medical emergency team intervention at the end of life for people with advanced cancer

European Journal of Oncology Nursing ◽

10.1016/j.ejon.2017.10.005 ◽

2017 ◽

Vol 31 ◽

pp. 77-83 ◽

Cited By ~ 3

Author(s):

Christine Brown ◽

Allison Drosdowsky ◽

Meinir Krishnasamy

Keyword(s):

End Of Life ◽

Advanced Cancer ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team

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Comparison of policies for recognising and responding to clinical deterioration across five Victorian health services

Australian Health Review ◽

10.1071/ah16265 ◽

2018 ◽

Vol 42 (4) ◽

pp. 412 ◽

Cited By ~ 5

Author(s):

Julie Considine ◽

Anastasia F. Hutchison ◽

Helen Rawson ◽

Alison M. Hutchinson ◽

Tracey Bucknall ◽

...

Keyword(s):

Patient Safety ◽

Health Services ◽

Medical Emergency Team ◽

National Standards ◽

Clinical Deterioration ◽

Medical Emergency ◽

Emergency Team ◽

Subacute Care ◽

Guidance Documents ◽

Activation Criteria

Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to individual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.

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