Skip to main content
SpringerLink
Log in

Reducing in-hospital cardiac arrests and hospital mortality by introducing a medical emergency team

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

To prospectively evaluate the implementation of a rapid response team in the form of a medical emergency team (MET) with regard to cardiac arrests and hospital mortality.

Methods

Prospective before-and-after trial of implementation of a MET at the Karolinska University Hospital, Stockholm, Sweden. All adult patients, apart from cardiothoracic, admitted to the hospital were regarded as participants in the study. A control period of 5 years and 203,892 patients preceded the 2-year intervention period of 73,825 patients.

Main results

Number of MET calls was 9.3 per 1,000 hospital admissions. Cardiac arrests per 1,000 admissions decreased from 1.12 to 0.83, OR 0.74 (95% CI 0.55–0.98, p = 0.035). Adjusted for age, sex, hospital length of stay, acute/elective admission as well as co-morbidities, MET implementation was associated with a reduction in total hospital mortality by 10%, OR 0.90 (95% CI 0.84–0.97), p = 0.003. Hospital mortality was also reduced for medical patients by 12%, OR 0.88 (95% CI 0.81–0.96, p = 0.002) and for surgical patients not operated upon by 28%, OR 0.72 (95% CI 0.56–0.92, p = 0.008).

For patients fulfilling the MET criteria

Thirty-day mortality pre-MET was 25% versus 7.9% following MET compared with historical controls. Similarly, 180-day mortality was 37.5% versus 15.8%, respectively.

Conclusions

Implementing the MET team was associated with significant improvement in both cardiac arrest rate and overall adjusted hospital mortality. Significant reductions in hospital mortality for un-operated surgical patients as well as for medical patients were also seen. Thus, introduction of the MET seemed to improve outcome for hospitalized patients.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL (1990) Clinical antecedents to in-hospital cardiopulmonary arrest. Chest 98:1388–1392

    Article  CAS  PubMed  Google Scholar 

  2. Hillman KM, Bristow PJ, Chey T, Daffurn K, Jacques T, Norman SL, Bishop GF, Simmons G (2002) Duration of life-threatening antecedents prior to intensive care admission. Intensive Care Med 28:1629–1634

    Article  PubMed  Google Scholar 

  3. Peberdy MA, Kaye W, Ornato JP, Larkin GL, Nadkarni V, Mancini ME, Berg RA, Nichol G, Lane-Trultt T (2003) Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation 58:297–308

    Article  PubMed  Google Scholar 

  4. Hillman KM, Bristow PJ, Chey T, Daffurn K, Jacques T, Norman SL, Bishop GF, Simmons G (2001) Antecedents to hospital deaths. Intern Med J 31:343–348

    Article  CAS  PubMed  Google Scholar 

  5. Sandroni C, Nolan J, Cavallaro F, Antonelli M (2006) In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med 33:237–245

    Article  PubMed  Google Scholar 

  6. Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K (2004) A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom–the ACADEMIA study. Resuscitation 62:275–282

    Article  PubMed  Google Scholar 

  7. Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV (2002) Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 324:387–390

    Article  PubMed  Google Scholar 

  8. Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart GK, Opdam H, Silvester W, Doolan L, Gutteridge G (2003) A prospective before-and-after trial of a medical emergency team. Med J Aust 179:283–287

    PubMed  Google Scholar 

  9. DeVita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL (2004) Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care 13:251–254

    Article  CAS  PubMed  Google Scholar 

  10. Offner PJ, Heit J, Roberts R (2007) Implementation of a rapid response team decreases cardiac arrest outside of the intensive care unit. J Trauma 62:1223–1227 discussion 1227–1228

    Article  PubMed  Google Scholar 

  11. Hillman K, Chen J, Cretikos M, Bellomo R, Brown D, Doig G, Finfer S, Flabouris A (2005) Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 365:2091–2097

    Article  PubMed  Google Scholar 

  12. Lee A, Bishop G, Hillman KM, Daffurn K (1995) The medical emergency team. Anaesth Intensive Care 23:183–186

    CAS  PubMed  Google Scholar 

  13. Subbe CP, Kruger M, Rutherford P, Gemmel L (2001) Validation of a modified early warning score in medical admissions. QJM 94:521–526

    Article  CAS  PubMed  Google Scholar 

  14. Bell MB, Konrad D, Granath F, Ekbom A, Martling CR (2006) Prevalence and sensitivity of MET-criteria in a Scandinavian University Hospital. Resuscitation 70:66–73

    Article  PubMed  Google Scholar 

  15. Bellomo R, Goldsmith D, Uchino S, Buckmaster J, Hart G, Opdam H, Silvester W, Doolan L, Gutteridge G (2004) Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med 32:916–921

    Article  PubMed  Google Scholar 

  16. Statistics S (2004) SCB

  17. Lunde AS, Lundeborg S, Lettenstrom GS, Thygesen L, Huebner J (1980) The person-number systems of Sweden, Norway, Denmark, and Israel. Vital Health Stat 2:1–59

    Google Scholar 

  18. Winters BD, Pham JC, Hunt EA, Guallar E, Berenholtz S, Pronovost PJ (2007) Rapid response systems: a systematic review. Crit Care Med 35:1238–1243

    Article  PubMed  Google Scholar 

  19. DeVita MA, Bellomo R (2007) The case of rapid response systems: are randomized clinical trials the right methodology to evaluate systems of care? Crit Care Med 35:1413–1414

    Article  PubMed  Google Scholar 

  20. Chan PS, Khalid A, Longmore LS, Berg RA, Kosiborod M, Spertus JA (2008) Hospital-wide code rates and mortality before and after implementation of a rapid response team, pp 2506–2513

  21. Reynolds SF, Bellomo R, Hillman K (2009) Rapid response team implementation and hospital mortality rates. JAMA 301:1659 author reply 1660

    Article  CAS  PubMed  Google Scholar 

  22. Tolchin S, Brush R, Lange P, Bates P, Garbo JJ (2007) Eliminating preventable death at Ascension Health. Jt Comm J Qual Patient Saf 33:145–154

    PubMed  Google Scholar 

  23. Jones D, Bellomo R, Bates S, Warrillow S, Goldsmith D, Hart G, Opdam H, Gutteridge G (2005) Long-term effect of a medical emergency team on cardiac arrests in a teaching hospital. Crit Care 9:R808–R815

    Article  PubMed  Google Scholar 

  24. Calzavacca P, Licari E, Tee A, Egi M, Haase M, Haase-Fielitz A, Bellomo R (2008) A prospective study of factors influencing the outcome of patients after a medical emergency team review. Intensive Care Med 34:2112–2116

    Article  PubMed  Google Scholar 

  25. Jones D, Opdam H, Egi M, Goldsmith D, Bates S, Gutteridge G, Kattula A, Bellomo R (2007) Long-term effect of a medical emergency team on mortality in a teaching hospital. Resuscitation 74:235–241

    Article  PubMed  Google Scholar 

  26. Devita MA, Bellomo R, Hillman K, Kellum J, 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, Harvey M, Galhotra S (2006) Findings of the first consensus conference on medical emergency teams. Crit Care Med 34:2463–2478

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge the invaluable help and support with implementing and running the MET from Rolf Söderlund, RN, Eva-Maria Wallin, RN, Åsa Bengtsson, RN and Katarina Karlsson, RN. We would also like to extend our gratitude to all staff at the Karolinska making the MET work. This study was supported by grants from the Laerdal foundation and funds from the Karolinska Institute.

Author information

Authors and Affiliations

  1. Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care, Karolinska Institute, 171 76, Stockholm, Sweden

    David Konrad, Gabriella Jäderling, Max Bell & Claes-Roland Martling

  2. Department of Medicine, Clinical Epidemiology Unit, Karolinska Institute, 171 76, Stockholm, Sweden

    Fredrik Granath & Anders Ekbom

  3. Department Anesthesiology and Intensive care, Karolinska University Hospital, 17176, Stockholm, Sweden

    David Konrad

Authors
  1. David Konrad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gabriella Jäderling
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Max Bell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fredrik Granath
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anders Ekbom
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Claes-Roland Martling
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Konrad.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 46 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Konrad, D., Jäderling, G., Bell, M. et al. Reducing in-hospital cardiac arrests and hospital mortality by introducing a medical emergency team. Intensive Care Med 36, 100–106 (2010). https://doi.org/10.1007/s00134-009-1634-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-009-1634-x

Keywords

Search

Navigation