Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 144 No. 4142 (2014)

Intensive care without walls – introduction of a Medical Emergency Team system in a Swiss tertiary care centre

  • Reto Etter
  • Jukka Takala
  • Tobias Michael Merz
DOI
https://doi.org/10.4414/smw.2014.14027
Cite this as:
Swiss Med Wkly. 2014;144:w14027
Published
05.10.2014

Summary

QUESTIONS UNDER STUDY: To improve the response of deteriorating patients during their hospital stay, the University Hospital Bern has introduced a Medical Emergency Team (MET). Aim of this retrospective cohort study is to review the preceding factors, patient characteristics, process parameters and their correlation to patient outcomes of MET calls since the introduction of the team.

METHODS: Data on patient characteristics, parameters related to MET activation and intervention and patient outcomes were evaluated. A Vital Sign Score (VSS), which is defined as the sum of the occurrence of each vital sign abnormalities, was calculated for all physiological parameters pre MET event, during event and correlation with hospital outcomes.

RESULTS: A total of 1,628 MET calls in 1,317 patients occurred; 262 (19.9%) of patients with MET calls during their hospital stay died. The VSS pre MET event (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.50–2.13; AUROC 0.63; all p <0.0001) and during the MET call (OR 1.60, 95% CI 1.41–1.83; AUROC 0.62; all p <0.0001) were significantly correlated to patient outcomes. A significant increase in MET calls from 5.2 to 16.5 per 1000 hospital admissions (p <0.0001) and a decrease in cardiac arrest calls in the MET perimeter from 1.6 in 2008 to 0.8 per 1000 admissions was observed during the study period (p = 0.014).

CONCLUSIONS: The VSS is a significant predictor of mortality in patients assessed by the MET. Increasing MET utilisation coincided with a decrease in cardiac arrest calls in the MET perimeter.

References

  1. Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ: Canadian Medical Association journal = journal de l’Association medicale canadienne. 2004;170(11):1678–86.
  2. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991;324(6):370–6.
  3. Zegers M, de Bruijne MC, Wagner C, Hoonhout LH, Waaijman R, Smits M, et al. Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study. Quality & safety in health care. 2009;18(4):297–302.
  4. Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom– the ACADEMIA study. Resuscitation. 2004;62(3):275–82.
  5. Storm-Versloot MN, Verweij L, Lucas C, Ludikhuize J, Goslings JC, Legemate DA, et al. Clinical relevance of routinely measured vital signs in hospitalized patients: a systematic review. Journal of nursing scholarship: an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau. 2014;46(1):39–49.
  6. Buist M, Bernard S, Nguyen TV, Moore G, Anderson J. Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation. 2004;62(2):137–41.
  7. Hillman KM, Bristow PJ, Chey T, Daffurn K, Jacques T, Norman SL, et al. Duration of life-threatening antecedents prior to intensive care admission. Intensive care medicine. 2002;28(11):1629–34.
  8. Wilson RM, Harrison BT, Gibberd RW, Hamilton JD. An analysis of the causes of adverse events from the Quality in Australian Health Care Study. Med J Aust. 1999;170(9):411–5.
  9. Hodgetts TJ, Kenward G, Vlackonikolis I, Payne S, Castle N, Crouch R, et al. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002;54(2):115–23.
  10. Institute for Healthcare Improvement. 5 Million Lives Campaign. [http://www.ihi.org/engage/initiatives/completed/5MillionLivesCampaign/Pages/default.aspx]
  11. Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation. 2010;81(10):1219–76.
  12. Acutely Ill Patients in Hospital: Recognition of and Response to Acute Illness in Adults in Hospital. London: National Institute for Health and Clinical Excellence; 2007.
  13. Manthous CA: Rapid-response teams. N Engl J Med. 2011;365(14):1356; author reply 1356–7.
  14. Devita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med. 2006;34(9):2463–78.
  15. Cretikos M, Parr M, Hillman K, Bishop G, Brown D, Daffurn K, et al. Guidelines for the uniform reporting of data for Medical Emergency Teams. Resuscitation. 2006;68(1):11–25.
  16. Peberdy MA, Cretikos M, Abella BS, DeVita M, Goldhill D, Kloeck W, et al. Recommended guidelines for monitoring, reporting, and conducting research on medical emergency team, outreach, and rapid response systems: an Utstein-style scientific statement: a scientific statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian Resuscitation Council, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, and the New Zealand Resuscitation Council); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiopulmonary, Perioperative, and Critical Care; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation. 2007;116(21):2481–500.
  17. Merz TM, Etter R, Mende L, Barthelmes D, Wiegand J, Martinolli L, et al. Risk assessment in the first fifteen minutes: a prospective cohort study of a simple physiological scoring system in the emergency department. Crit Care. 2011;15(1):R25.
  18. Etter R, Ludwig R, Lersch F, Takala J, Merz TM. Early prognostic value of the medical emergency team calling criteria in patients admitted to intensive care from the emergency department. Crit Care Med. 2008;36(3):775–81.
  19. Gao H, McDonnell A, Harrison DA, Moore T, Adam S, Daly K, et al. Systematic review and evaluation of physiological track and trigger warning systems for identifying at-risk patients on the ward. Intensive care medicine. 2007;33(4):667–79.
  20. Price RJ, Cuthbertson BH, Cairns CJ. The findings of the International Conference on Medical Emergency Teams are biased and misleading. Crit Care Med. 2007;35(3):992–3.
  21. Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet. 2005;365(9477):2091–97.
  22. Chen J, Bellomo R, Flabouris A, Hillman K, Finfer S. The relationship between early emergency team calls and serious adverse events. Crit Care Med. 2009;37(1):148–53.
  23. Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C. Rapid Response Teams: A Systematic Review and Meta-analysis. Arch Intern Med. 2010;170(1):18–26.
  24. Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM. Rapid-response systems as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):417–25.
  25. Foraida MI, DeVita MA, Braithwaite RS, Stuart SA, Brooks MM, Simmons RL. Improving the utilization of medical crisis teams (Condition C) at an urban tertiary care hospital. J Crit Care. 2003;18(2):87–94.
  26. Baxter AD, Cardinal P, Hooper J, Patel R. Medical emergency teams at The Ottawa Hospital: the first two years. Canadian journal of anaesthesia = Journal canadien d’anesthesie. 2008;55(4):223–31.
  27. Jones D, Bellomo R, DeVita MA. Effectiveness of the Medical Emergency Team: the importance of dose. Crit Care. 2009;13(5):313.
  28. Harm F, Ummenhofer W, Luethy M, Zuercher M. In-hospital cardiac arrest after leaving a monitored bed-do we transfer patients too early? Resuscitation. 2012;83:e7.
  29. Morris DS, Schweickert W, Holena D, Handzel R, Sims C, Pascual JL, et al. Differences in outcomes between ICU attending and senior resident physician led medical emergency team responses. Resuscitation. 2012;83(12):1434–7.
  30. Mitchell A, Schatz M, Francis H. Designing a critical care nurse-led rapid response team using only available resources: 6 years later. Crit Care Nurse. 2014;34(3):41–55; quiz 56.

Most read articles by the same author(s)