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Association between implementation of an intensivist-led medical emergency team and mortality
  1. Constantine J Karvellas1,
  2. Ivens A O de Souza1,2,
  3. R T Noel Gibney1,
  4. Sean M Bagshaw1
  1. 1Division of Critical Care Medicine, University of Alberta, Edmonton, Canada
  2. 2Department of Intensive Care Medicine, Hospital Sirio-Libanes, San Paolo, Brazil
  1. Correspondence to Dr Sean M Bagshaw, Division of Critical Care Medicine, University of Alberta Hospital, 3C1.16 Walter C. Mackenzie Centre, 8440-122 Street, Edmonton, Alberta, Canada T6G2B7; bagshaw{at}ualberta.ca

Abstract

Purpose To evaluate the impact of implementation of a dedicated intensivist-led medical emergency team (IL-MET) on mortality in patients admitted to the intensive care unit (ICU).

Methods All adult ward admissions to the ICU between July 2002 and December 2009 were reviewed (n=1920) after excluding readmissions and admissions for <24 h. IL-MET hours were defined as 8:00–15:59 (Monday to Friday). The following periods were analysed: period 1: 1 July 2002–31 August 2004 (control); period 2: 1 September 2004–11 February 2007 (partial MET without dedicated intensivist); and period 3: 12 February 2007–31 December 2009 (hospital-wide IL-MET).

Results During all three periods, there were no significant differences in length of stay or mortality (IL-MET vs non-IL-MET hours, p>0.1 for all). On multivariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score and age were independently associated with mortality in all three periods (p<0.05 for all). During period 3, there was a non-significant trend towards decreased mortality if admitted during IL-MET hours (OR 0.73, 95% CI 0.51 to 1.03, p=0.08). During period 3, there was a non-significant trend towards decreased mortality if admitted during IL-MET hours (OR 0.73, 95% CI 0.51 to 1.03, p=0.08). However, this result likely reflects the observed increase in mortality during non-IL MET hours rather than improved mortality during IL-MET hours.

Conclusion In a single centre experience, implementation of an IL-MET did not reduce the rate of in-hospital death or lengths of stay.

  • Critical care
  • rapid response teams
  • medical emergency team
  • crisis management
  • healthcare quality improvement
  • implementation science
  • hospital medicine
  • decision support
  • computerised
  • transitions in care
  • evidence-based medicine
  • health services research
  • patient safety

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Footnotes

  • Funding Dr Bagshaw is supported by a Canada Research Chair in Critical Care Nephrology and Clinical Investigator Award from Alberta Innovates—Health Solutions (formerly Alberta Heritage Foundation for Medical Research).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by University of Alberta Health Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data available on request from the corresponding author.

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