Clinical paperThe impact of introducing medical emergency team system on the documentations of vital signs☆
Introduction
The medical emergency team (MET) systems is part of a rapid response team (RRT) concept that aims to provide timely critical care support to ward patients at risk of serious adverse events.1 An effective RRT system is dependent upon doctors and/or nurses activating the team for at risk patients. Activation is typically triggered by concern about the patient's clinical condition and/or the presence of abnormal vital signs. Activation based on abnormal vital signs depends on their measurement, the recognition of abnormal values and timely communication. There is evidence that activation of the MET system is frequently sub-optimal because of failures in measurement, documentation, understanding and communication of vital sign abnormalities.1
The MERIT study, a 23-hospital cluster randomised clinical trial evaluated the effectiveness of the MET system.1 As part of the study, investigators collected information on the value of three vital signs (blood pressure, respiratory rate and heart rate), within the 24 h prior to an adverse event or emergency team call. The adverse events were unplanned intensive care admissions unexpected cardiac arrests, and unexpected deaths defined as a cardiac arrests or a death without a do not resuscitate (DNR) order.
We used the data collected during the MERIT study to investigate the relationship between the rate of documentation of three vital signs (blood pressure, respiratory rate and heart rate) in Australian hospitals and the occurrence of adverse events and emergency team calls, and to examine the effect, if any, of the introduction of a MET system on the rate of vital sign documentation.
Section snippets
Study design
The MERIT study was a cluster randomised controlled trial of 23 Australian hospitals that tested the effectiveness of introducing a MET system. The method of hospital recruitment, randomisation and implementation of the MET during the MERIT study has been described previously.1 All participating hospitals received approval from their Human Research Ethics Committees to conduct the study. We collected data for a 2-month baseline period, a 4-month standardised implementation period (during which
Results
We examined the rate of missing respiratory rate, heart rate and blood pressure for 881 unexpected deaths; 3021 unplanned ICU admissions; 1348 unexpected cardiac arrests; 1754 emergency team calls; and 5988 events in total. The sum of the individual types of event (7004) was greater than the total number of event (5988). This was due to overlap in some definitions of the individual event types. For example, a patient who had a cardiac arrest and died without a pre-existing NFR order was
Discussion
We used collected data from the MERIT study to assess the completeness of documentation of three vital signs (blood pressure, respiratory rate and heart rate) before an adverse event or emergency team call not associated with an adverse event. We found marked variability in levels of documentation from hospital to hospital, and a very high proportion of missing documentation of vital signs. Allocation to the MET system was associated with a statistically significant improvement in documentation
Conflicts of interest statement
All authors stated that they had no conflicts of interest to declare.
Acknowledgements
The study was funded by grants from the National Health and Medical Research Council of Australia, the Australian Council for Safety and Quality in Health Care and the Australian and New Zealand Intensive Care Foundation as part of the MERIT study.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2008.10.009.