Abstract
ObjectiveMedical emergency teams (MET) are mostly led by physicians. Some hospitals are currently using nurse practitioners (NP) to lead MET calls. These are no studies comparing clinical outcomes between these two care models. To determine whether NP-led MET calls are associated with lower risk of acute patient deterioration, when compared to intensive care (ICU) registrar (ICUR)-led MET calls.MethodsThe composite primary outcome included recurrence of MET call, occurrence of code blue or ICU admission within 24 h. Secondary outcomes were mortality within 24 h of MET call, length of hospital stay, hospital mortality and proportion of patients discharged home. Propensity score matching was used to reduce selection bias from confounding factors between the ICUR and NP group.ResultsA total of 1343 MET calls were included (1070 NP, 273 ICUR led). On Univariable analysis, the incidence of the primary outcome was higher in ICUR-led MET calls (26.7% vs. 20.6%, p = 0.03). Of the secondary outcome measures, mortality within 24 h (3.4% vs. 7.7%, p = 0.002) and hospital mortality (12.7% vs. 20.5%, p = 0.001) were higher in ICUR-led MET calls. Propensity score-matched analysis of 263 pairs revealed the composite primary outcome was comparable between both groups, but NP-led group was associated with reduced risk of hospital mortality (OR 0.57, 95% CI 0.35–0.91, p = 0.02) and higher likelihood of discharge home (OR 1.55, 95% CI 1.09–2.2, p = 0.015).ConclusionAcute patient deterioration was comparable between ICUR- and NP-led MET calls. NP-led MET calls were associated with lower hospital mortality and higher likelihood of discharge home.
Highlights
Over the last two decades, establishment of rapid response systems (RRS) in healthcare services has led to a reduction of in-hospital mortality and incidence ofGupta et al Crit Care (2021) 25:117[4, 5]
Propensity score-matched analysis of 263 pairs revealed the composite primary outcome was comparable between both groups, but nurse practitioners (NP)-led group was associated with reduced risk of hospital mortality and higher likelihood of discharge home
Acute patient deterioration was comparable between Intensive care unit registrar (ICUR)- and NP-led Medical emergency teams (MET) calls
Summary
Over the last two decades, establishment of rapid response systems (RRS) in healthcare services has led to a reduction of in-hospital mortality and incidence ofGupta et al Crit Care (2021) 25:117[4, 5]. The nurse-led MET teams are second most common model reported in the literature [6]. Physicians attending these MET calls generally have other defined roles. To reduce disruptions to the critical care staff with defined roles, a small proportion of healthcare services have introduced trained nurse practitioners (NP) employed to lead MET call response. The aim was to compare clinical outcomes including subsequent acute deterioration as evidenced by recurrence of MET call, occurrence of code blue or ICU admission within 24 h of first MET call between NP- and ICUR-led MET calls (NPMET study). We hypothesized that the primary composite outcome comprising recurrence of MET call, occurrence of code blue or admission to ICU within 24 h of the MET calls would not be different between NP- and ICUR-led MET calls
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