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Abstract

Introduction: Medical emergency teams (METs) utilize a multidisciplinary strategy to better anticipate and prevent in-hospital morbidity and mortality. In general, the responsibilities of the team include diagnosing clinical problems, initiating therapy, and when appropriate, triaging patients to higher levels of care. However, there are no specific guidelines as to who should lead METs, thus the composition of these teams varies among institutions. Hypothesis: The objective of our study was to compare patient outcomes when the MET at a tertiary academic medical center was lead by emergency medicine physicians to critical care medicine trained intensivists. Methods: We conducted a retrospective study comparing the rate of intubation, intensive care unit (ICU) admission, and all-cause hospital mortality in a three month interval when the MET was staffed solely by emergency medicine physicians (interval A, October 1, 2010-December 31, 2010) to a three month interval (interval B, April 1, 2011-June 30 2011) when the MET was staffed by either emergency medicine physicians or intensivists. Results: The MET was activated 391 times during interval A and 390 times during interval B. There was no difference between the intervals in rate of intubation (7.4% vs 7.4%, p=0.36) or mortality (20.7% vs 21%, p=0.35). However, there was a lower rate of ICU admissions in interval B by 68.2% (45% vs 14.6%, p<0.01). This decline could not be explained by physician specialty since there was no significant difference in admission rate between the two groups (13.8% by emergency medicine physicians and 16.8% by intensivists, p=0.20). The difference could also not be explained by severity of illness since the mean APACHE II score for all patients admitted to the ICU was 73.5 during interval A and 70.7 during interval B. Conclusions: Our study shows that the specialty of the physicians leading METs does not impact the rate of intubation or mortality. Interestingly, we observed a significant decline in the ICU admission rate between the two study intervals which could not explained by physician specialty or severity of illness. Informal surveys of MET members suggested that through experience, the team was spending more time and effort managing patients on the floors and had improved communication with the primary services. However, prospective and long term studies are needed.