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

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.

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

The Ultrasound Journal ◽

10.1186/s13089-021-00229-3 ◽

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

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Abstract 11: Medical Emergency Teams Reduce Unexpected Cardiac Arrests, But Not Overall Hospital Costs Per Case

Circulation ◽

10.1161/circ.116.suppl_16.ii_925-a ◽

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.

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High Rate of Medical Emergency Team Activation in Children with Tracheostomy

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-1695733 ◽

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.

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The risk of postoperative deterioration of non-cardiac surgery patients with ICU referral status who are admitted to the regular ward: a retrospective observational cohort study

Patient Safety in Surgery ◽

10.1186/s13037-021-00283-9 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

David Moore ◽

Matthew L. Durie ◽

Sohail Bampoe ◽

Luke Buizen ◽

Jai N. Darvall

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Quality Improvement ◽

Intensive Care Unit Admission ◽

Medical Emergency Team ◽

Surgical Patients ◽

Medical Emergency ◽

Improvement Program ◽

Surgical Quality ◽

Emergency Team

Abstract Background Higher-risk surgical patients may not be admitted to the intensive care unit due to stable immediate post-operative status on review. The outcomes of this cohort are not well described. Our aim was to examine the subsequent inpatient course of intensive care unit -referred but not admitted surgical patients. Methods All patients aged ≥18 years who were referred but not admitted for post-operative management in a tertiary metropolitan intensive care unit following non-cardiac surgery between 1/7/2017 and 30/6/2018 were eligible for inclusion in this retrospective observational cohort study. Primary outcome was Medical Emergency Team activation. Secondary outcomes included unplanned intensive care unit admission; length of stay; and 30-day mortality. Risk of serious complications and predicted length of stay were calculated using the National Surgical Quality Improvement Program scoring tool. Results Fifteen of 60 patients (25%) had a MET-call following surgery, eight (13%) patients required unplanned intensive care unit admission, with median (IQR) time to Medical Emergency Team call 9 (6–13) hours. No patients died within 30-days. There was no significant difference between mean National Surgical Quality Improvement Program predicted and actual length of stay; after adjustment, National Surgical Quality Improvement Program predicted risk of serious complications was associated with unplanned intensive care unit admission (OR [95% CI] = 1.08 [1.00–1.16], p = 0.04), although not Medical Emergency Team calls. Conclusions Post-operative deterioration occurs frequently, and early, in a cohort of high-risk surgical patients initially assessed as being safe for ward care. Changes to current triage models for post-operative intensive care unit admission may reduce the impact of complications in this high-risk group.

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Diagnostic accuracy of symptoms as a diagnostic tool for SARS-CoV 2 infection: a cross-sectional study in a cohort of 2,173 patients

BMC Infectious Diseases ◽

10.1186/s12879-021-05930-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Carlos Alfonso Romero-Gameros ◽

Tania Colin-Martínez ◽

Salomón Waizel-Haiat ◽

Guadalupe Vargas-Ortega ◽

Eduardo Ferat-Osorio ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Diagnostic Tool ◽

Clinical Decision Making ◽

Multivariate Logistic Regression Analysis ◽

Clinical Decision ◽

Cross Sectional Study ◽

World Health ◽

Likelihood Ratios ◽

Cross Sectional ◽

Health Organization

Abstract Background The SARS-CoV-2 pandemic continues to be a priority health problem; According to the World Health Organization data from October 13, 2020, 37,704,153 confirmed COVID-19 cases have been reported, including 1,079,029 deaths, since the outbreak. The identification of potential symptoms has been reported to be a useful tool for clinical decision-making in emergency departments to avoid overload and improve the quality of care. The aim of this study was to evaluate the performances of symptoms as a diagnostic tool for SARS -CoV-2 infection. Methods An observational, cross-sectional, prospective and analytical study was carried out, during the period of time from April 14 to July 21, 2020. Data (demographic variables, medical history, respiratory and non-respiratory symptoms) were collected by emergency physicians. The diagnosis of COVID-19 was made using SARS-CoV-2 RT-PCR. The diagnostic accuracy of these characteristics for COVID-19 was evaluated by calculating the positive and negative likelihood ratios. A Mantel-Haenszel and multivariate logistic regression analysis was performed to assess the association of symptoms with COVID-19. Results A prevalence of 53.72% of SARS-CoV-2 infection was observed. The symptom with the highest sensitivity was cough 71%, and a specificity of 52.68%. The symptomatological scale, constructed from 6 symptoms, obtained a sensitivity of 83.45% and a specificity of 32.86%, taking ≥2 symptoms as a cut-off point. The symptoms with the greatest association with SARS-CoV-2 were: anosmia odds ratio (OR) 3.2 (95% CI; 2.52–4.17), fever OR 2.98 (95% CI; 2.47–3.58), dyspnea OR 2.9 (95% CI; 2.39–3.51]) and cough OR 2.73 (95% CI: 2.27–3.28). Conclusion The combination of ≥2 symptoms / signs (fever, cough, anosmia, dyspnea and oxygen saturation < 93%, and headache) results in a highly sensitivity model for a quick and accurate diagnosis of COVID-19, and should be used in the absence of ancillary diagnostic studies. Symptomatology, alone and in combination, may be an appropriate strategy to use in the emergency department to guide the behaviors to respond to the disease. Trial registration Institutional registration R-2020-3601-145, Federal Commission for the Protection against Sanitary Risks 17 CI-09-015-034, National Bioethics Commission: 09 CEI-023-2017082.

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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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