Clinical paperLong-term effect of a Medical Emergency Team on mortality in a teaching hospital☆
Introduction
Despite advances in medical care and the introduction of cardiac arrest teams, adverse events including unexpected deaths and cardiac arrests continue to affect 4–19% of admissions in the United States of America1 and Australia.2 Unexpected deaths and cardiac arrests are frequently preceded by a period of physiological instability3, 4, 5 indicating that they are neither sudden nor unpredictable.6 This observation has led to the conception of Medical Emergency Teams (MET) comprised of doctors and nurses skilled in advanced resuscitation of the acutely unwell patient. The MET is an example of a Rapid Response Team (RRT) and can be activated by any member of hospital staff according to preset criteria of physiological instability. The aim of the MET service is to rapidly mobilise appropriately trained staff to deliver prompt and definitive treatment in the early phase of clinical deterioration and, hence, reduce cardiac arrests and mortality.7
In a recent short term before-and-after intervention study in our hospital, the introduction of an intensive care based MET service was associated with a reduced incidence of post-operative adverse outcomes, post-operative mortality, and mean duration of hospital stay in patients undergoing major surgery.8
Little information exists on the sustainability and continued effectiveness of the MET over an extended period. Indeed, the effectiveness of the MET in a hospital system may be diminished over time due to employment of new junior medical staff and nurses who are unfamiliar with the MET concept or reluctant to breach “traditional” hierarchical system of patient management.6, 9, 10
There has been a progressive increase in the use of the MET system at our institution.11 In addition, the rate of increase of MET activation for surgical patients was 4.9-fold greater than that for medical patients.11 We hypothesised that this sustained MET use might result in a continued reduction in hospital mortality. We tested this hypothesis by conducting a study of the effect of sustained MET use on the hospital mortality of patients for the 4 year period after its introduction.
Section snippets
Methods
We obtained Institutional Review Board approval for the introduction of the MET and for the collection of data related to it. The need for informed consent was waived by the Institutional Review Board.
Effect of the introduction of the MET service on mortality of surgical patients
“Before” the introduction of the MET system there were 7441 surgical admissions and 209 deaths (28.09 deaths/thousand admissions) (Table 1). There was a near significant reduction in the number of surgical deaths/1000 patient admissions during the “education phase” (but not during the “run-in” period) and “after” the introduction of the MET (Figure 1, Table 1). Thus, the odds ratio (OR) of death for surgical patients during the phase of “education” for the MET was 0.82 (95% CI = 0.67–1.00; p =
Discussion
We conducted a long-term assessment of the effect of the MET service on in-hospital mortality and found a statistically significant reduction in the number of deaths in surgical patients over an extended period. In contrast, the number of deaths amongst medical patients increased “during” and “after” the introduction of the MET system, and has remained higher than the “before” MET period.
A detailed programme of staff education and feedback has been associated with progressive uptake and use of
Conclusion
Introduction of an intensive care based Medical Emergency Team, in conjunction with a detailed programme of continuing staff education and feedback was associated with a reduction in post-operative surgical deaths at our institution. This benefit was seen rapidly during the pre-MET education phase of our intervention. In contrast, the number of deaths in medical patients rose during the education phase for the MET, and has remained higher than the before-MET period. The differential effects of
Conflict of interest
None of the authors has any conflict of interest to declare in relation to this study.
References (15)
- et al.
Redefining in-hospital adult resuscitation: the concept of the medical emergency team
Resuscitation
(2001) - et al.
Improving the utilization of Medical Crisis Teams (Condition C) at an Urban Tertiary Care Hospital
J Crit Care
(2003) - et al.
Evaluation of a medical emergency team one year after implementation
Resuscitation
(2004) - et al.
The quality of health care delivery to adults in the United States
N Engl J Med
(2003) - et al.
The quality in Australian health care study
MJA
(1995) - et al.
Recognizing clinical instability in hospital patients before cardiac arrests or unplanned admissions to intensive care
MJA
(1999) - et al.
Developing strategies to prevent in-hospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event
Crit Care Med
(1994)
Cited by (72)
Effects of rapid response team on patient outcomes: A systematic review
2024, Heart and LungBreaches of pre-medical emergency team call criteria in an Australian hospital
2023, Critical Care and ResuscitationThe role of the primary care team in the rapid response system
2015, Journal of Critical CareAlarm systems for the detection of patients at risk. Clinical and healthcare repercussions
2014, Medicina IntensivaPredictors of mortality and cost among surgical patients requiring rapid response team activation
2021, Canadian Journal of Surgery
- ☆
A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2006.12.007.