How Residents MET their training: Resident’s perception of Medical Emergency Team and its contribution to their Training

Mapping Intimacies ◽

10.21203/rs.2.22725/v1 ◽

2020 ◽

Author(s):

Kangqi Ng ◽

Daryl Jones ◽

Augustine Tee

Keyword(s):

Internal Medicine ◽

Online Survey ◽

Improve Patient Safety ◽

Core Competencies ◽

Medical Emergency Team ◽

Learning Goals ◽

Medical Emergency ◽

Formal Training ◽

Emergency Team ◽

Medical Emergencies

Abstract Background Medical Emergency Teams (MET) have been implemented in many hospitals to improve patient safety. Few studies examined how residents perceive the MET as part of training. Objective We aimed to evaluate residents’ perceptions of how MET rotation affected training in the core competencies specified by Accreditation Council for Graduate Medical Education (ACGME). Methods We conducted an online survey of 106 residents. They are either junior residents who are in training in internal medicine, non-trainee registrars or senior residents who are training in respiratory or advanced internal medicine. Results We achieved a response rate of 62.3%. More than 90% of residents agreed or strongly agreed that MET contributed positively to their training, made resuscitation of patients safer and more efficient, and disagreed or strongly disagreed that MET made resuscitation of patients more time-consuming or cumbersome. More than 80% agreed or strongly agreed that the MET improved their clinical judgement in medical emergencies, helped achieve their learning goals and exposed them to a wide variety of cases. At least two-thirds thought that the MET posting improved their procedural skills and communication in end of life care discussions. In contrast, 26.6% of respondents agreed or strongly agreed that the MET decreased autonomy of the primary team. One-third felt they needed formal training for the MET posting. Conclusion Our findings suggest that residents perceive participation in MET was beneficial in training and improved patient care. We also found that formal training and consultant oversight may be needed for junior team leaders of MET.

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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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Abstract 462: Medical Emergency Team Replaces Code Blue Activations at Pediatric Hospital

Circulation ◽

10.1161/circ.140.suppl_2.462 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Elizabeth Masse ◽

Joan S Roberts

Keyword(s):

Life Support ◽

Medical Emergency Team ◽

Medical Emergency ◽

Pediatric Hospital ◽

Free Standing ◽

Emergency Team ◽

Charge Nurse ◽

Code Blue ◽

Pediatric Hospitals ◽

Medical Emergencies

Introduction: In free-standing pediatric hospitals, the Code Blue team may be activated for events in adults to provide triage, resuscitation, medical screening exams, EMTALA documentation and disposition decisions. However, activation of the Code Blue team can require significant time and critical care resources and may delay patient care if the activation is external to the building. Hypothesis: Development of a small triage team focused on specific adult triage algorithms will provide a safe, effective and efficient alternative to Code Blue team response. Methods: 407 bed tertiary pediatric hospital, within metropolitan area. Collaborative multi-disciplinary QI process to design and simulate the roles, workflow and documentation of the Medical Emergency Team (MET). Education and communication to hospital-wide staff on MET, as well as MET responders completion of Advanced Cardiac Life Support course. Collaboration with local EMS leadership to coordinate transfer of patient was also undertaken. Results: MET roles were developed and two configurations of the MET team were implemented July 2018: one inside the footprint of the building and anther outside the footprint of the building, including the hospital grounds. The teams consisted of a mid-level provider, charge nurse, two security officers and a shift administrator: inside team relied on ICU provider and charge nurse, while outside team led by Emergency Medicine provider and charge nurse. Each team had a backpack with supplies, and transport gurney. Since inception, 199 activations occurred, 191 inside and 8 outside the facility. The activations included 45 staff or volunteers, 84 adult visitors, 75 pediatric visitors. Outcome for the activations: 57 transported to the hospital ED, 47 transported to another facility, 21 refused treatment and 68 had resolution of concerns. EMTALA documentation was complete in 112/137 (82%). Conclusions: Pediatric hospitals have substantial adult populations, where medical emergencies that arise rely on Code Blue in medical emergencies for simplicity. Development of a response team for nonpatients allows specific training, triage, and processes to improve care and reduce drain on ICU resources.

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ICU shift related effects on sleep, fatigue and alertness levels

Occupational Medicine ◽

10.1093/occmed/kqaa013 ◽

2020 ◽

Vol 70 (2) ◽

pp. 107-112 ◽

Cited By ~ 3

Author(s):

S Bihari ◽

A Venkatapathy ◽

S Prakash ◽

E Everest ◽

D McEvoy R ◽

...

Keyword(s):

Shift Work ◽

Improve Patient Safety ◽

Night Shift ◽

Medical Emergency Team ◽

Study Data ◽

Medical Emergency ◽

Full Time ◽

Emergency Team ◽

The Difference ◽

Psychomotor Vigilance

Abstract Background Shift work may lead to suboptimal sleep resulting in impaired alertness, and lowered performance levels, all of which can lead to medical errors. Aims To examine fatigue, sleepiness and behavioural alertness prospectively in a tertiary level Australian intensive care unit (ICU). Methods All full-time doctors providing 24-h resident cover on a 12-h day and 12-h night shift roster were invited to participate in this study. Data collected included Epworth Sleepiness Scale (ESS), sleep and awake history, Samn-Perelli Fatigue (SPF) Scale, Karolinska Sleepiness Scale (KSS) and iOS-based Psychomotor Vigilance Test (behavioural alertness). Data about medical emergency team (MET) shifts were collected separately as they were perceived to be busier shifts. Results Twenty-nine ICU doctors participated in this study for a consecutive 6-week period. At baseline the median (interquartile range (IQR)) ESS was 5 (3–9). Day shift leads to an increase in fatigue and sleepiness (both P < 0.01). Night shift leads to worsening in fatigue, sleepiness and psychomotor vigilance (all P < 0.01). MET shifts had a lower psychomotor vigilance than non-MET shifts. The difference in the psychomotor vigilance was mostly due to the difference in recorded lapses and response time. Conclusions Shift work ICU doctors experience high levels of fatigue and sleepiness. Night shifts also lead to decreased vigilance. This is even more evident in doctors working MET shifts. These factors may lead to errors. Optimal rostering may reduce these effects and improve patient safety.

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Features, Risk Factors, and Outcomes of Older Internal Medicine Patients Triggering a Medical Emergency Team Call

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.14014 ◽

2021 ◽

Author(s):

Piyumi Wijesundera ◽

Emily J See ◽

Raymond Robbins ◽

Amy Crosthwaite ◽

David Smallwood ◽

...

Keyword(s):

Internal Medicine ◽

Risk Factors ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team ◽

Medical Emergency Team Call

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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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