Medical Emergency Team Intervention Research Articles

Medical emergency team interventions to suspected stroke and stroke mortality during the COVID-19 pandemic in Poland

Medical emergency team interventions to suspected stroke and stroke mortality during the COVID-19 pandemic in Poland

Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study

This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.

Risk Factors for Early Medical Emergency Team Reactivation in Hospitalized Patients.

The objective of this study was to investigate the risk factors for early medical emergency team reactivation (which is defined as repeated medical emergency team calls within 72 hr after the index medical emergency team call) in the patients remaining on the ward after index medical emergency team activation. Retrospective analysis with prospectively collected data. A university-affiliated, tertiary referral hospital. All consecutive patients over 18 years old who received medical emergency team intervention. None. Of the 3,989 cases eligible for analysis, 514 cases (12.9%) were classified into the reactivation group, with the remainder assigned to the nonreactivation group. In a multivariate analysis, chronic lung disease (odds ratio, 1.38; 95% CI, 1.03-1.86; p = 0.032), chronic liver disease (odds ratio, 1.44; 95% CI, 1.04-1.99; p = 0.028), activation due to bedside concern about overall deterioration without abnormal physiological variables (odds ratio, 1.30; 95% CI, 1.00-1.68; p = 0.049), advice or consultation only for medical emergency team intervention (odds ratio, 0.78; 95% CI, 0.63-0.97; p = 0.027), and discussion about treatment limitation (odds ratio, 0.39; 95% CI, 0.25-0.60; p < 0.001) were independently associated with medical emergency team reactivation. In the reactivation group, 249 patients (48.5%) were transferred to the ICU after repeated calls. Medical department admission (odds ratio, 1.68; 95% CI, 1.12-2.52; p = 0.012), chronic liver disease (odds ratio, 1.73; 95% CI, 1.07-2.79; p = 0.025), hematological malignancies (odds ratio, 1.63; 95% CI, 1.10-2.41; p = 0.015), and tachypnea at the end of medical emergency team were risk factors for medical emergency team reactivation requiring ICU admission. Discussion about treatment limitation (odds ratio, 0.14; 95% CI, 0.05-0.40; p < 0.001) was also associated with decreased risk of medical emergency team reactivation requiring ICU admission. An increased risk of early medical emergency team reactivation was associated with medical emergency team activation by bedside concern about overall deterioration and patients with chronic lung or liver disease.

Medical emergency team interventions in patients with ST-segment elevation myocardial infarction in Poland in 2018.

The National Emergency Medical Services Management Support System, a unique information and communication technology system, was developed to reduce the burden of ST-segment elevation myocardial infarction (STEMI) in Poland. According to the European Society of Cardiology guidelines, medical emergency teams (METs) should diagnose STEMI using electrocardiogram (ECG) transmission and apply dual antiplatelet therapy (DAPT) as a pivotal treatment. This study aimed to analyze MET interventions in patients with STEMI and assess regional differences in the management in Poland. Using ambulance call reports, we retrospectively analyzed MET interventions due to conditions classified as I21 (acute myocardial infarction; according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision), which were performed in Poland between January 1, 2018 and December 31, 2018. In 2018, METs conducted 16 807 interventions classified as I21, which accounted for 0.5% of all MET interventions in Poland in that year. Most interventions were conducted in the Mazovia Province (13.4%; P<0.001), and the lowest number was reported in the Podlasie Province (2.5%). A 12‑lead ECG was performed during 98.6% of interventions, and ECG transmission in 37.49%: most often in the Mazovia Province (59.62%; P<0.001), and least often in the Lublin Province (13.8%). In 72.12% of interventions, DAPT was applied: clopidogrel was the P2Y12 inhibitor used in 49.68% of interventions, and ticagrelor in 25.14% (P<0.001). A P2Y12 inhibitor was most often used in the Wielkopolska Province (98.4%), and least often in the Silesia Province (40.34%). Significant differences in the implementation of the European Society of Cardiology guidelines regarding ECG transmission and DAPT were observed between particular provinces in Poland.

The effectiveness of a national early warning score as a triage tool for activating a rapid response system in an outpatient setting: A retrospective cohort study.

Rapid response system (RRS) efficacy and national early warning score (NEWS) performances have largely been reported in inpatient settings, with few such reports undertaken in outpatient settings.This study aimed to investigate NEWS validity in predicting poor clinical outcomes among outpatients who had activated the RRS using single-parameter criteria.A single-center retrospective cohort studyFrom April 1, 2014 to November 30, 2017 in an urban 350-bed referral hospital in JapanWe collected patient characteristics such as activation triggers, interventions, arrival times, dispositions, final diagnoses, and patient outcomes. Poor clinical outcomes were defined as unplanned intensive care unit transfers or deaths within 24 hours. Correlations between the NEWS and clinical outcomes at the time of deterioration and disposition were analyzed.Among 31 outpatients, the NEWS value decreased significantly after a medical emergency team intervention (median, 8 vs 4, P < .001). The difference in the NEWS at the time of deterioration and at disposition was significantly less in patients with poor clinical outcomes (median 3 vs 1.5, P = .03). The area under the curve (AUC) for the NEWS high-risk patient group at the time of deterioration for predicting hospital admission was 0.85 (95% confidence interval [CI], 0.67-1.0), while the AUC for the NEWS high-risk patient group at disposition for predicting poor clinical outcomes was 0.83 (95% CI, 0.62-1.0).The difference between the NEWS at the time of deterioration and at disposition might usefully predict admissions and poor clinical outcomes in RRS outpatient settings.

Patient perceptions of deterioration and patient and family activated escalation systems-A qualitative study.

To investigate the experiences of patients who received a medical emergency team review following a period of clinical deterioration and their views about the potential use of a patient and family activated escalation system. Delay or failure by health professionals to respond to clinical deterioration remains a patient safety concern. Patients may sometimes identify subtle cues of early deterioration prior to changes in vital signs. In response to health professional and system failures, patient and family activated escalation systems have been mandated and implemented in Australia. However, little research has evaluated their effectiveness nor taken patients' perspectives into account. Qualitative exploratory descriptive design was used. Purposive sampling was used. Semistructured interviews were undertaken in 2014 with 33 patients who required medical emergency team intervention. Data were collected from one private and one public hospital in Melbourne, Victoria, Australia. The framework method was used to analyse the data. All patients stated that it was the clinician who detected and responded to deterioration. Private patient participants were unaware of the medical emergency team system, and felt escalating care was not their responsibility. These patients reported being too sick to communicate prior to and during medical emergency team review and did not favour a patient and family activated escalation system. Public patients were well informed about the medical emergency team system yet expressed concerns around overriding clinicians if activating a patient and family activated escalation system. Patient participation during a period of deterioration is restricted by their clinical condition and limited medical knowledge. Patients felt comfortable to communicate concerns to clinicians but felt they would not activate the patient and family activated escalation system. This behoves clinicians to actively listen and respond to patient concerns. Clinicians must promote a collaborative relationship and encourage patients to communicate their concerns. Given the perceived barriers to patient and family activated escalation systems use, resources being employed for their implementation could be redistributed to other areas of patient safety.

A Quality Improvement Initiative to Reduce "Out-of-ICU" Cardiopulmonary Arrests in a Tertiary Care Hospital in India: A 2-Year Learning Experience.

To assess impact of medical emergency team (MET) in reducing "out-of-ICU" cardiopulmonary arrests and identify barriers to its optimal utilization. Frequently observed critical clinical signs and laboratory values of "out-of-ICU" crashes were used to develop Amrita Early Warning Criteria. A physician-led MET was established to respond to code MET, activated by a primary nurse. Rates of "out-of-ICU" cardiopulmonary arrests per 1000 admissions were compared in pre-MET (2013-2014) and post-MET periods (2014-2016) along with disposition following MET and mortality. Descriptive statistics and logistic regression were used for comparative analysis. For continued quality improvement, a Likert agreement scale questionnaire collated the nurse's feedback on MET. 386 Code MET were recorded with an activation rate of 18.8 per 1000 inpatients for 2014-2016. Common MET triggers were desaturation (53%), seizure (10%), and syncope (9%). Seventy-one percent of activations were attended within 5 minutes, with 45% reported during nurse's night shift hours. Medical emergency team interventions resulted in 59% being shifted to ICU. In the "post-MET" period, "Cold Blue" dose reduced from 6.9 in 2013-2014 to 2.6 (P = .0002) in 2014-2015 and 3.2 (P = .01) in 2015-2016. Ninety-three percent of the Code Blues with prior MET calls were "delayed MET" and 28% of the Code Blues without prior MET activation were "missed MET." Nurse's feedback revealed that 46% lacked knowledge of correct MET activation process while 31% expressed a fear of reprisal for inappropriate activation. Although MET intervention was successful in significantly reducing "out-of-ICU" Code Blues, focused training of nurses is required for continued quality improvement.

An exploration of medical emergency team intervention at the end of life for people with advanced cancer.

Recent advances in cancer therapies offer survival benefit when cure is no longer possible. The contribution of the Medical Emergency Teams (METs) in the context of advancing disease has received little empirical consideration. This study set out to explore MET intervention at the end of life for people with advanced cancer in an Australian comprehensive cancer centre, and its impact on quality of death. A retrospective medical chart review was undertaken to explore MET response for people with advanced (incurable) cancer nearing end of life. Occurrence of MET interventions at the end of life and a quality of death score were recorded for two randomly selected cohorts of patients, those who experienced a MET response within their last week of life (n=50) and those who did not (n=50). The cohort who did not receive MET intervention had a significantly higher (better) quality of death score when compared with patients who did receive a MET intervention (p=0.01). Within the cohort who received a MET intervention, a subgroup (n=19) where the MET influenced end-of-life decision-making had a significantly higher quality of death score (p=0.02) than patients in the MET cohort (n=31) where the MET did not influence end-of-life care. The contribution of the MET to end-of-life care for patients with cancer has not previously been reported. Further research is now needed to prospectively examine MET involvement at the end of life with consideration to quality of patient care and death, family experience, and support requirements of MET members.

Factors affecting attitudes and barriers to a medical emergency team among nurses and medical doctors: A multi-centre survey

AimTo identify factors underlying attitudes towards the medical emergency team (MET) and barriers to its utilisation among ward nurses and physicians. MethodsMulticentre survey using an anonymous questionnaire in hospitals with a fully operational MET system in the Piedmont Region, Italy. Response to questions was scored on a 5-point Likert-type agreement scale. Dichotomised results were included in a logistic regression model. ResultsAmong 2279 staff members who were contacted, 1812 (79.6%) completed the survey. The vast majority of respondents valued the MET. Working in a surgical vs. medical ward and having participated in either the MET educational programme (METal course) or MET interventions were associated with better acceptance of the MET system. Reluctance by nurses to call the covering doctor first instead of the MET for deteriorating patients (62%) was significantly less likely in those working in surgical vs. medical wards or having a higher seniority or a METal certification (OR 0.51 [0.4–0.65], 0.69 [0.47–0.99], and 0.6 [0.46–0.79], respectively). Reluctance to call the MET in a patient fulfilling calling criteria (21%), was less likely to occur in medical doctors vs. nurses and in surgical vs. medical ward staff, and it was unaffected by the METal certification. ConclusionsThe MET was well accepted in participating hospitals. Nurse referral to the covering physician was the major barrier to MET activation. Medical status, working in surgical vs. medical wards, seniority and participation in the METal educational programme were associated with lower likelihood of showing barriers to MET activation.

Are there any differences in medical emergency team interventions between rural and urban areas? A single-centre cohort study

To compare interventions of medical emergency teams in urban and rural areas with particular emphasis on response time and on-site medical rescue activities. A retrospective analysis of ambulance call reports from two emergency medical service substations: one in the city and the other in a rural area. Two emergency medical service substations: one in the city and the other in a rural area. Medical emergency teams. Interventions in the city were associated with a substantially shorter response time in comparison to rural areas. In the city, the distances were generally less than 10 km. In the rural area, however, such short distances accounted for only 7.2% of events, while 33.8% were over 30 km. Medical emergency teams more often acted exclusively on-site or ceased any interventions in rural areas. Compared with the city, actions in the rural setting were associated with significantly increased use of cervical collars and decreased use of intravenous access. The presence of a physician in the team raised the probability of pharmacotherapy. The relationship between medical emergency teams activities and the location of intervention shows the real diversity of the functioning of emergency medical service within a city and rural areas. Further research should aim to improve the generalisability of these findings.

Activation of a Medical Emergency Team Using an Electronic Medical Recording–Based Screening System*

To evaluate the efficacy of a medical emergency team activated using 24-hour monitoring by electronic medical record-based screening criteria followed by immediate intervention by a skilled team. Retrospective cohort study. Academic tertiary care hospital with approximately 2,700 beds. A total of 3,030 events activated by a medical emergency team from March 1, 2008, to February 28, 2010. None. We collected data for all medical emergency team activations: patient characteristics, trigger type for medical emergency team (electronic medical record-based screening vs calling criteria), interventions during each event, outcomes of the medical emergency team intervention, and 28-day mortality after medical emergency team activation. We analyzed data for 2009, when the medical emergency team functioned 24 hours a day, 7 days a week (period 2), compared with that for 2008, when the medical emergency team functioned 12 hours a day, 7 days a week (period 1). The commonest cause of medical emergency team activation was respiratory distress (43.6%), and the medical emergency team performed early goal-directed therapy (21.3%), respiratory care (19.9%), and difficult airway management (12.3%). For patients on general wards, 51.3% (period 1) and 38.4% (period 2) of medical emergency team activations were triggered by the electronic medical record-based screening system (electronic medical record-triggered group). In 23.4%, activation occurred because of an abnormality in laboratory screening criteria. The commonest activation criterion from electronic medical record-based screening was respiratory rate (39.4%). Over half the patients were treated in the general ward, and one third of the patients were transferred to the ICU. The electronic medical record-triggered group had lower ICU admission with an odds ratio of 0.35 (95% CI, 0.22-0.55). In surgical patients, the electronic medical record-triggered group showed the lower 28-day mortality (10.5%) compared with the call-triggered group (26.7%) or the double-triggered group (33.3%) (odds ratio 0.365 with 95% CI, 0.154-0.867, p = 0.022). We successful managed the medical emergency team with electronic medical record-based screening criteria and a skilled intervention team. The electronic medical record-triggered group had lower ICU admission than the call-triggered group or the double-triggered group. In surgical patients, the electronic medical record-triggered group showed better outcome than other groups.

Patient Characteristics and Disposition After Pediatric Medical Emergency Team (MET) Activation: Disposition Depends on Who Activates the Team

This study focused on health care staff (HCS) responsible for activating the medical emergency team (MET) at a pediatric tertiary hospital using a well-established rapid response system. Our goals were to report the patient characteristics, MET interventions, and disposition by activating HCS. This is a retrospective cohort study of pediatric patients who received MET activation at the Children's Hospital of Eastern Ontario in Ottawa, Canada. Data were obtained from a prospectively maintained rapid response system database. The primary outcome was PICU admission, with the number and type of interventions performed as secondary outcomes. The most common MET activators were physicians (410, 53.3%) with nurses generating a comparable number (367, 47.7%). Significant differences in PICU admission rates were observed between activator groups, with physicians having statistically higher PICU admission rates when compared with nurses (25.2% vs 15.0%, P = .001). Compared with physicians, nursing-led activations on surgical patients had significantly lower odds of PICU admission relative to medical patients (odds ratio 0.19 vs 0.67; P = .03). No significant difference was observed in the type or number of interventions between any subgroup based on patient (surgery vs medical) or activator type. This study suggests that when nurses activate MET, patients are less likely to be transferred to the PICU despite receiving similar type and number of interventions. Our study results may help direct education initiatives aimed at enhancing the effectiveness of the afferent limb through informing specific HCS as to the importance of their role in using the MET.

Does Medical Emergency Team Intervention Reduce the Prevalence of Emergency Endotracheal Intubation Complications?

PurposeEmergency endotracheal intubation (EEI) is a complex process that leads to various complications. Previous studies mainly demonstrated that the Medical Emergency Team (MET) intervention reduced the incidence of cardiac arrest, however, the impact of a MET on airway management has not been investigated in detail. Our purpose was to confirm the impact of a MET on airway management and compare the incidence of complications of EEI before and after MET intervention in a general ward.Materials and MethodsWe performed an observational study and reviewed 318 patients intubated by a MET in a general ward.ResultsThe patients enrolled during the control (2007) and study (2009) periods were 103 and 215, respectively. Cardiopulmonary resuscitation requiring emergency intubation in a general ward was reduced after MET intervention at the Asan Medical Center (39.8% vs. 19.1%, p<0.001). Pre-intubation and post-intubation oxygen saturation levels were higher after MET intervention (pre-intubation, 80% before vs. 92% after MET, p<0.001; post-intubation, 95% before vs. 99% after MET, p<0.001). The use of vasopressors after intubation decreased as a result of MET intervention (62.1% before vs. 36.7% after MET, p<0.001). Hypotension was also reduced (34% before vs. 8.8% after MET, p<0.001).ConclusionEarly interventions of a MET changed the causes of emergency intubation in a general ward from cardiopulmonary resuscitation to respiratory distress or shock and improved hypoxemia and hypotension related to emergency intubation. The MET intervention is safe and effective system for emergency intubation in a general ward.

Comorbid Conditions in Patients Requiring Medical Emergency Team Intervention

Comorbid Conditions in Patients Requiring Medical Emergency Team Intervention

Evaluation of a medical emergency team one year after implementation.

To evaluate the activity and impact of a Medical Emergency Team (MET) one year after implementation. A 700-bed District General Hospital (DGH) in Southeast England with approximately 53,500 adult admissions per annum. The population studied included all adult admissions receiving intervention by the MET during a 12-month period between 1 October 2000 and 30 September 2001. Analysis of the activation of the MET using both prospective and retrospectively acquired data. Routinely collected hospital data for admissions, discharges and deaths was used to compare outcomes for the 12 months before and after the introduction of the MET. There were 136 activations of MET over 1-year. Six cases were excluded. Mean age of patients was 73 years (range 20-97 years). 40% (52/130) survived to discharge following MET intervention. Of those who died 22% (28/130) were designated 'not for resuscitation'. Patients that died were more likely to have three or more physiological abnormalities present (odds ratio, OR 6.2, Chi-square (chi(2)) P = 0.004) and had higher MET scores (P = 0.004). Commonest interventions by the MET were initiation or increase of oxygen therapy or ventilatory support (80%), with or without the administration of intravenous fluids or medications. In 10% of cases, oxygen therapy was the sole intervention. One year after implementation of the MET a reduction in cardiac arrest rate and overall mortality was noted but this was not statistically significant. Often only simple interventions are only required to reverse deterioration. Initiating 'do not attempt resuscitation' (DNAR) decisions is a key part of MET activity. Multiple physiological abnormalities are associated with increased mortality and therefore wider and earlier application of the MET to the hospital population may save lives or expedite DNAR decisions. New systems need time to develop ("bed in") and further research is needed to observe significant reductions in cardiac arrests and overall mortality.

Evaluation of a Medical Emergency Team one year after implementation

<h2>Abstract</h2> <i>Aim:</i> To evaluate the activity and impact of a Medical Emergency Team (MET) one year after implementation. <i>Setting and population:</i> A 700-bed District General Hospital (DGH) in Southeast England with approximately 53,500 adult admissions per annum. The population studied included all adult admissions receiving intervention by the MET during a 12-month period between 1 October 2000 and 30 September 2001. <i>Methods:</i> Analysis of the activation of the MET using both prospective and retrospectively acquired data. Routinely collected hospital data for admissions, discharges and deaths was used to compare outcomes for the 12 months before and after the introduction of the MET. <i>Results:</i> There were 136 activations of MET over 1-year. Six cases were excluded. Mean age of patients was 73 years (range 20–97 years). 40% (52/130) survived to discharge following MET intervention. Of those who died 22% (28/130) were designated ‘not for resuscitation'. Patients that died were more likely to have three or more physiological abnormalities present (odds ratio, OR 6.2, Chi-square (<i>χ</i>²) <i>P</i>=0.004) and had higher MET scores (<i>P</i>=0.004). Commonest interventions by the MET were initiation or increase of oxygen therapy or ventilatory support (80%), with or without the administration of intravenous fluids or medications. In 10% of cases, oxygen therapy was the sole intervention. One year after implementation of the MET a reduction in cardiac arrest rate and overall mortality was noted but this was not statistically significant. <i>Conclusion:</i> Often only simple interventions are only required to reverse deterioration. Initiating ‘do not attempt resuscitation' (DNAR) decisions is a key part of MET activity. Multiple physiological abnormalities are associated with increased mortality and therefore wider and earlier application of the MET to the hospital population may save lives or expedite DNAR decisions. New systems need time to develop ("bed in") and further research is needed to observe significant reductions in cardiac arrests and overall mortality.

The Medical Emergency Team

The concept of a Medical Emergency Team was developed in order to rapidly identify and manage seriously ill patients at risk of cardiopulmonary arrest and other high-risk conditions. The aim of this study was to describe the utilization and outcome of Medical Emergency Team interventions over a one-year period at a teaching hospital in South Western Sydney. Data was collected prospectively using a standardized form. Cardiopulmonary resuscitation occurred in 148/522 (28%) calls. Alerting the team using the specific condition criteria occurred in 253/522 (48%) calls and on physiological/pathological abnormality criteria in 121/522 (23%) calls. Survival rate to hospital discharge following cardiopulmonary arrest was low (29%), compared with other medical emergencies (76%).