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
- transitions in care
- evidence-based medicine
- health services research
- patient safety
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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.