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Illness severity characteristics and outcomes of patients remaining on an acute ward following medical emergency team review: a latent profile analysis
  1. Anthony Batterbury1,2,
  2. Clint Douglas2,3,
  3. Lee Jones4,5,
  4. Fiona Coyer2,6
  1. 1Safety and Implementation Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  2. 2School of Nursing, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
  3. 3Office of Nursing and Midwifery Services, Metro North Hospital and Health Service, Herston, Queensland, Australia
  4. 4School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
  5. 5Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
  6. 6Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
  1. Correspondence to Dr Anthony Batterbury, Safety and Implementation Service, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia; anthony.batterbury{at}health.qld.gov.au

Abstract

Background Patients requiring medical emergency team (MET) review have complex clinical needs, and most remain on the ward after review. Current detection instruments cannot identify post-MET patient requirements, meaning patients remain undistinguished, potentially resulting in missed management opportunities. We propose that deteriorating patients will cluster along dimensions of illness severity and that these clusters may be used to strengthen patient risk management practices.

Objective To identify and define the number of illness severity clusters and report outcomes among ward patients following MET review.

Study design and setting This retrospective cohort study examined the clinical records of 1500 adult ward patients following MET review at an Australian quaternary hospital. Three-step latent profile analysis methods were used to determine clusters using Sequential Organ Failure Assessment (SOFA) and Nursing Activities Score (NAS) as illness severity indicators. Study outcomes were (1) hospital mortality, (2) unplanned intensive care unit (ICU) admission and (3) subsequent MET review.

Results Patients were unplanned (73.9%) and medical (57.5%) admissions with at least one comorbidity (51.4%), and complex combinations of acuity (SOFA range 1–17) and dependency (NAS range 22.4%–148.5%). Five clusters are reported. Patients in cluster 1 were equivalent to clinically stable general ward patients. Organ failure and complexity increased with cluster progression—clusters 2 and 3 were equivalent to subspecialty/higher-dependency wards, and clusters 4 and 5 were equivalent to ICUs. Patients in cluster 5 had the greatest odds for death (OR 26.2, 95% CI 23.3 to 31.3), unplanned ICU admission (OR 3.1, 95% CI 3.0 to 3.1) and subsequent MET review (OR 2.4, 95% CI 2.4 to 2.6).

Conclusion The five illness severity clusters may be used to define patients at risk of poorer outcomes who may benefit from enhanced levels of monitoring and targeted care.

  • Medical emergency team
  • Complexity
  • Hospital medicine
  • Patient safety
  • Standards of care

Data availability statement

Data are available upon reasonable request. Data are maintained by the statutory data custodian in accordance with local ethical standards and information governance protocols.

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Data availability statement

Data are available upon reasonable request. Data are maintained by the statutory data custodian in accordance with local ethical standards and information governance protocols.

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Footnotes

  • Twitter @DrClintDouglas

  • Contributors AB extracted the data and conducted the statistical analyses, with guidance from CD and LJ. All authors were involved in the conception of the paper. AB wrote the initial draft, and all authors were involved in editing the final manuscript. AB accepts full responsibility for the work as guarantor.

  • Funding This study was funded by State of Queensland Department of Health (NMRF-R5-2019), Australian Commonwealth Research Training Programme (no award/grant number).

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.