Abstract
AimTo determine the distribution of outcomes following a medical emergency team (MET) call using a modified version of the multidisciplinary audit and evaluation of outcomes of rapid response (MAELOR) tool, and to evaluate its usefulness in monitoring the performance of the efferent limb of the rapid response system (RRS) at our institution.MethodAn observational study of prospectively collected data including all MET calls at our institution during the 36 weeks study period (23 December 2013 – 31 august 2014). Outcomes of MET calls were registered 24 h after the call occurred and categorized according to the MAELOR tool.ResultsFifty-five of a total of 308 MET calls were excluded due to prior limitations in treatment. Of the remaining cases 66 % had positive outcomes. Thirty two percent of the calls resulted in transfer to the ICU, of these 73 % occurred within 4 h. Patients remained on the ward in 53 % of the cases, and 56 % of these were no longer triggering at follow up. Nine patients had died at follow-up, three without a DNAR order. Three patients were lost to follow-up, two patients were discharged from the hospital and 25 remained alive on the ward with a DNAR as a consequence of the MET call.ConclusionsICU transfer was implemented rapidly in most cases once the decision was made, but a disturbingly large number of patients, who remained on the ward were still triggering at 24 h follow-up. We found the MAELOR-tool useful to evaluate RRS efferent limb performance.
Highlights
It is well documented that serious adverse events (SAEs) such as cardiac arrest, unanticipated intensive care unit (ICU) admission and unexpected death among hospitalized patients frequently are preceded by signs of physiological instability [1, 2]
In May 2012 the single parameter track and trigger system at our hospital was replaced by an aggregated weighted track and trigger system (AWTT) based on National Early Warning Score (NEWS) that includes measures for respiratory rate, arterial hemoglobin oxygen saturation, pulse rate, systolic blood pressure, level of consciousness according to AVPU score, temperature, and whether the patient receives supplementary oxygen (Table 1) [13]
Three patients were lost to follow-up, two patients were discharged from the hospital and 25 remained alive on the ward with a do not attempt resuscitation (DNAR) as a consequence of the medical emergency team (MET) call
Summary
It is well documented that serious adverse events (SAEs) such as cardiac arrest, unanticipated intensive care unit (ICU) admission and unexpected death among hospitalized patients frequently are preceded by signs of physiological instability [1, 2]. To prevent these events from occurring an increasing number of hospitals use rapid response systems (RRS) to identify at-risk patients early and intervene appropriately. RRS consist of an afferent limb with a track-and-trigger system based on vital signs to identify deteriorating patients early and trigger a call to the efferent limb, usually a medical emergency team (MET).
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