Skip to main content

Advertisement

Log in

A prospective study of factors influencing the outcome of patients after a Medical Emergency Team review

  • Brief Report
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To identify factors that predict outcome in patients receiving a Medical Emergency Team review.

Design

Prospective observational study.

Setting

Tertiary hospital.

Patients

Cohort of 228 patients receiving one or more Medical Emergency Team reviews during daytime hours over a 1-year-period. Control cohort of all patients (n = 900) receiving a Medical Emergency Team review in the same period.

Measurements and results

We prospectively collected information from patients receiving a Medical Emergency Team review during daytime hours from Monday to Friday (audit group) including the clinical cause of deterioration and timing of call in relation to the first documented Medical Emergency Team call criterion (activation delay). We also collected information from the hospital Medical Emergency Team database regarding all patients visited by the Medical Emergency Team during the same period (complete cohort). Audit group patients had several similar characteristics to complete cohort patients but were less likely to be not-for-resuscitation before Medical Emergency Team review and more likely to receive a Medical Emergency Team review because of hypotension, change in neurological status and oliguria. Delayed Medical Emergency Team activation and not-for resuscitation orders were the only factors to show an independent statistical association with mortality (OR 2.53, 95% CI: 1.2–5.31, P = 0.01 and OR 5.63, 95% CI: 2.81–11.28, P < 0.01, respectively).

Conclusion

Delayed Medical Emergency Team activation and NFR orders are the strongest independent predictors of mortality in patients receiving a Medical Emergency Team review. Avoidance of delayed Medical Emergency Team activation should be a priority for hospitals operating rapid response systems.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, Newhouse JP, Weiler PC, Hiatt HH (2004) Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I. Qual Saf Health Care 13:145–151

    Article  PubMed  CAS  Google Scholar 

  2. DeVita MA, Bellomo R, Hillman K, Kellum JA, Rotondi A, Teres D, Auerbach A, Chen WJ, Duncan K, Kenward G, Bell M, Buist M, Chen J, Bion J, Kirby A, Lighthall G, Ovreveit J, Braithwaite RS, Gosbee J, Milbrandt E, Peberdy M, Savitz L, Young L, Galhotra R (2006) Findings of the first consensus conference on medical emergency teams. Crit Care Med 34:2463–2478

    Article  PubMed  Google Scholar 

  3. Buist M, Burton P, Bernard S, Waxman B, Anderson J (1999) Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. Med J Aust 23:183–186

    Google Scholar 

  4. Tee A, Calzavacca P, Licari E, Goldsmith D, Bellomo R (2008) Bench-to-bedside review: the MET syndrome—the challenges of researching and adopting medical emergency teams. Crit Care 12:205

    Article  PubMed  Google Scholar 

  5. Jones DA, Goldsmith D, Green J, Briedis J, Bellomo R, Casamento A, Kattula A, Way M (2006) Medical emergency team syndromes and an approach to their management. Crit Care 10:R30–R34

    Article  PubMed  Google Scholar 

  6. Cretikos M, Chen J, Hillman K, Bellomo R, Finfer S, Flabouris A, The MERIT study investigators (2007) The objective medical emergency team activation criteria: a case-control study. Resuscitation 73:62–72

    Article  PubMed  Google Scholar 

  7. For ICD 10 classification refer to website of the World Health Organization: http://www.who.int/classifications/apps/icd/icd10online/

  8. Kenward G, Castle N, Hodgetts T, Shaikh L (2004) Evaluation of a medical emergency team one year after implementation. Resuscitation 61:257–263

    Article  PubMed  Google Scholar 

  9. Jones DA, Bates S, Warrillow S, Opdam H, Goldsmith D, Gutteridge G, Bellomo R (2005) Circadian pattern of activation of the medical emergency team in a teching hospital. Crit Care 9:R303–R306

    Article  PubMed  Google Scholar 

  10. DeVita MA (2005) Medical emergency teams: deciphering clues to crises in hospitals. Crit Care 9:325–326

    Article  PubMed  Google Scholar 

  11. Jones DA, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G, Opdam H (2006) Patient monitoring and the timing of cardiac arrests and medical emergency team calls in a teaching hospital. Intensive Care Med 32:1352–1356

    Article  PubMed  Google Scholar 

  12. Buist M (2008) The rapid response team paradox: why doesn’t anyone call for help? Crit Care Med 36:634–635

    PubMed  Google Scholar 

  13. Jones DA, McIntyre T, Baldwin I, Mercer I, Kattula A, Bellomo R (2007) The medical emergency team and end-of-life care: a pilot study. Crit Care Resus 9:151–156

    Google Scholar 

  14. Jones DA, Egi M, Bellomo R, Goldsmith D (2007) Effect of the medical emergency team on long-term mortality following major surgery. Crit Care 11:R12

    Article  PubMed  Google Scholar 

  15. Fresco C, Carinci F, Maggioni AP, Ciampi A, Nicolucci A, Santoro E, Tavazzi L, Tognonia G (1999) Very early assessment of risk for inhospital death among 11, 483 patients with acute myocardial infarction. GISSI investigators. Am Heart J 138:1058–1064

    Article  PubMed  CAS  Google Scholar 

  16. Díez-Tejedor E, Fuentes B (2004) Acute care in stroke: the importance of early intervention to achieve better brain protection. Cerebrovasc Dis 17:130–137

    Article  PubMed  CAS  Google Scholar 

  17. McNicholl B (1995) The golden hour and prehospital trauma care. Injury 26:215–216

    Google Scholar 

  18. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy collaborative group: early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 8:1368–1377

    Article  Google Scholar 

  19. Downey AW, Quach J, Haase M, Haase-Fielitz A, Jones D, Bellomo R (2008) Characteristics and outcomes of patients receiving a medical emergency team review for acute change in conscious state or arrhythmias. Crit Care Med 36:477–481

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rinaldo Bellomo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Calzavacca, P., Licari, E., Tee, A. et al. A prospective study of factors influencing the outcome of patients after a Medical Emergency Team review. Intensive Care Med 34, 2112–2116 (2008). https://doi.org/10.1007/s00134-008-1229-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-008-1229-y

Keywords

Navigation