Medical Emergency Team System Research Articles

Implementasi Early Warning System (Ews) dalam Mendeteksi Perburukan Akut pada Pasien Dewasa di Ruang Rawat Inap Rumah Sakit

The purpose of this scoping review is to identify how the application of EWS to detecting acute deterioration in adult patients in general ward hospital. The method used was a scoping review and the literature has been obtained from searches derived from four databases originating from PubMed, Scopus, Sage, and CINAHL. The results showed that the implementation of EWS consisted of 6 components (vital sign recording, EWS scoring and reading, EWS protocol, clinical response based on escalation protocol, information assistance process using bundle communication (SBAR), medical emergency team (MET) system activation). Seven main of vital sign have to measured are respiratory rate, oxygen saturation, oxygen supplementation, temperature, pulse, systolic blood pressure, and level of consciousness. Persistence and additional commitment since 2009 were identified as significantly increasing benefits during the implementation of EWS instruments to improve patient outcomes. This success was obtained from experience that can increase the knowledge and competence of nurses. Changes in the risk of the EWS score can be read by nurses as an indication of clinical deterioration that requires stabilization interventions. Innovations have also been carried out since 2013 which have been successfully implemented in various countries, especially in 2019 and 2021 which are called EWS electronic. Based on this study, EWS proved to be accurate in detecting deterioration in patients. Therefore, to improve the implementation of EWS nurses must have good knowledge, because in implementing EWS requires critical thinking, and the ability to analyze numerical score classifications as a basis for decision making.
 
 Keywords: Early Warning System, EWS, Nurse Implementation, Patient deterioration.

Determine the Vital Sign Observations that can Detect Signs of Cardiopulmonary Arrest in Patients Receiving Internal Medicine Care

Background: In certain hospitals, the Medical Emergency Team (MET) has undergone development to provide prompt and efficient treatment, effectively preventing cardiac arrests. Our objective was to assess the efficiency of observational practices in identifying anomalies in vital signs before cardiac arrest and to evaluate the requirement for implementing a MET system in hospitals across Punjab. Methods: We conducted a comprehensive review of patient charts from four hospitals, specifically focusing on individuals who experienced cardiac arrest over a span of 12 months. We meticulously documented and analyzed the vital signs, symptoms, and interventions that occurred within the 12 hours leading up to the cardiac arrest, comparing them against the trigger criteria established by the Medical Emergency Team (MET). Results: Throughout the designated study period, a total of 130 patients experienced cardiac arrest while in hospitals, with 68 cases (52%) occurring on the wards. Among these patients, 34 individuals (41%) displayed abnormal vital signs that met the criteria established by the Medical Emergency Team (MET). These abnormalities were documented, on average, 3.7 hours prior to the cardiac arrest event. Notably, during this timeframe, 14 patients did not receive any form of intervention, such as supplemental oxygen or medication. Among the remaining patients, nine received intervention within 2 hours, while nine others received intervention after more than 1 hour. It is important to mention that none of the patients responded to the initial intervention. However, only one patient required subsequent re-interventions. Practical Implication: It is essential for healthcare providers in this field to be knowledgeable, skilled, and prepared to respond promptly and effectively to cardiopulmonary arrest emergencies. By staying updated on the latest guidelines and practicing interdisciplinary collaboration, healthcare teams can strive towards optimizing outcomes and ensuring the safety of their patients. Conclusion: There is a prevalent occurrence of notable physiological decline in the hours leading up to cardiac arrests within the wards of Punjab hospitals, indicating the potential value in implementing a Medical Emergency Team (MET) system. However, in order to fully capitalize on the benefits of a MET, it is crucial to enhance the practice of vital sign observation by the nursing staff. Keywords: Medical Emergency Team (MET), cardiac arrests, Internal Medicine.

Dosage and clinical outcomes of medical emergency team and conventional referral mediated unplanned intensive care admissions.

Background: Unplanned intensive care unit (ICU) admission occurs via activation of medical emergency team (MET) and conventional ICU referral (CIR), i.e., ICU consultation. We aimed to compare the dosage, association with unplanned ICU admissions and hospital mortality between MET and CIR systems. Methods: We performed a retrospective, single centre observational study on unplanned ICU admissions from hospital wards between July 2017 and June 2018. We evaluated the dosage (expressed per 1000 admissions) and association of CIR and MET system with unplanned ICU admission using Chi-square test. The relationship (unadjusted and adjusted to Australia and New Zealand risk of death (ANZROD) and lead time) between unplanned ICU admission pathway (MET vs CIR) and hospital mortality was tested by binary logistic regression analysis [Odds ratio (OR) with 95% confidence interval (CI)]. Results: Out of 38,628 patients hospitalised, 679 had unplanned ICU admission (2%) with an ICU admission rate of 18 per 1000 ward admissions. There were 2153 MET and 453 CIR activations, producing a dosage of 56 and 12 per 1000 admissions, respectively. Higher unplanned ICU admission was significantly associated with CIR compared to MET activation (324/453 (71.5%) vs 355/2153 (16.5%) p < 0.001). On binary logistic regression, MET system was significantly associated with higher hospital mortality on unadjusted analysis (OR 1.65 (95% CI: 1.09-2.48) p = 0.02) but not after adjustment with ANZROD and lead time (OR 1.15 (95% CI: 0.71-1.86), p = 0.58). Conclusions: Compared to CIR, MET system had higher dosage but lower frequency of unplanned ICU admissions and lacked independent association with hospital mortality.

Post-crisis debriefing: A tool for improving quality in the medical emergency team system

ObjectivesTo examine clinicians’ perception of quality of technical and non-technical response to emergencies and application of post crisis debriefing. DesignDescriptive, anonymous, self-reporting survey on the needs and perception of a post-crisis debriefing implementation. SettingMulti-specialist medical institute in Italy focused on solid organ transplantation and organ failure support. Main outcomesPerception of application of guidelines and evaluation of debriefing implementation during in-hospital emergencies. ResultsResponse rate to the survey was 25% (148 health care workers). Of all respondents, 86% were employed >10 years, 75% were involved in ≤5 emergencies over the previous year. Resuscitation guidelines were considered fully applied by 55%; 64% of respondents considered the teaching programme as sufficient. Of all participants, 97% were aware of the importance of teamwork dynamics, 79% were aware of the importance of the personal performance, and 52% considered emergencies as valid opportunities for professional growth. Leadership was considered important by 45% of respondents; debriefing implemented by 41%, and considered a potentially useful tool by 85%. ConclusionPost-crisis debriefing is a way to diffuse self-reflective and life-long learning culture; it is perceived as a powerful tool for improving quality of the rapid response system by the vast majority of those surveyed.

The Medical Emergency Team in Italy: an overview of in-hospital emergencies response.

Background and aim:Medical Emergency Team (MET), implemented in many hospitals worldwide, aims to improve the safety of in-hospital patients whose condition is deteriorating. This study describes MET presence and organization in the Italian National Healthcare System Hospitals.Methods:A national survey with an online questionnaire was performed. The questionnaire, created ad hoc, was sent by e-mail to the nursing coordinators and MET referents of the Hospitals affiliated to the Italian National Healthcare System with an Anesthesia and Intensive Care service.Results:One hundred-ninety-seven hospitals were interviewed (36.2% of the whole national network). A dedicated MET, composed at least by an intensivist and a nurse, was present only in 118 cases (59.9%). The team was composed by a non-dedicated staff (67.8% of doctors, 69.5% of nurses) and a minimum shared standard of education for the nurse component was absent. One third of the estimated hospitals did not use a warning score for emergency call activation.Discussion and conclusion:This survey showed a heterogenous and often lacking organization of in-hospital emergency management in Italy. MET system needs to be implemented in terms of presence in the Italian hospitals, and standardized for personnel structure and training, and equipment availability. A broader study is necessary to compare our data with those of other European Countries to better identify the specific areas which need to be improved more promptly. (www.actabiomedica.it)

528 Patient Outcomes Post Medical Emergency Team Calls and User Compliance of Track and Trigger Based Observation and Response Chart in Cardiology Patients

Early recognition of clinical deterioration has been associated with a lower level of intervention and reduced adverse events. A widely used approach in Australia is the Medical Emergency Team (MET) system. We conducted a prospective observational study of all inpatients under the general cardiology and heart failure(HF) teams for 30 days. Information was collected from the observation chart and the hospital database. There were 23 MET calls for total of 443 patient episodes. The indication for MET call are listed in the table. There were 20 episodes with appropriate modifications in place hence MET was not called. There was only 1 episode where MET call and 4 episodes where preMET call was inappropriately not called. Of the patients (n=27) who met the MET call criteria during their stay, 63% were admitted under HF team. 22% of the patients who met the MET call criteria required a procedure/ device insertion, 15% required ICU admission and 15% died. The average length of stay was 6.41 days. The higher MET call rate in heart failure vs general cardiology patients is expected and reflects the difference in patient population and co-morbidities. Most patients requiring activation of MET system were critically ill, requiring emergency treatment or procedure highlighting importance of this system. Continued exploration of workplace issues influencing the recognition and responses to unmet needs of a deteriorating patient in cardiology ward is recommended.Tabled 1MET criteriaTotal number of callsPulse<40bpm4Pulse>140bpm11SBP<90mmHg4Resp Rate >302RN worried2Total23 Open table in a new tab

Effectiveness of Education in Improving the Performance of Medical Emergency Team Nurses

BackgroundNumerous national safety organizations have recommended the use of a Medical Emergency Team (MET) system to improve hospital safety. However, there is little evidence regarding the effectiveness of the educational approaches used to train METs. ObjectiveTo evaluate how effective educational interventions are at improving the performances of MET nurses. MethodsA systematic literature review was conducted in five multi-disciplinary databases. The studies were selected and independently assessed by two researches. The analysis followed the principals of narrative synthesis. ResultsA lack of suitable studies meant that only two studies were analyzed. Nevertheless, they confirmed that simulation team training is an effective method and preferred among METs. The assumption of specific roles during training improved the task completion rate. ConclusionsThe effectiveness of MET educational interventions remains unclear due to a lack of published studies. Future studies on MET educational interventions should clarify and evaluate the roles of MET nurses and how they perform during emergency situations.

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.

The limitations in implementing and operating a rapid response system.

Despite the widespread introduction of rapid response systems (RRS)/medical emergency teams (MET), there is still controversy regarding how effective they are. While there are some observational studies showing improved outcomes with RRS, there are no data from randomised controlled trials to support the effectiveness. Nevertheless, the MET system has become a standard of care in many healthcare organisations. In this review, we present an overview of the limitations in implementing and operating a RRS in modern healthcare.

Reduction of unexpected serious adverse events after introducing medical emergency team.

To assess the clinical benefits of introducing a medical emergency team system for early medical intervention in hospital care. This prospective analysis included all cases of medical emergency team activation during the first year after the introduction of the medical emergency team system at Chiba University Hospital (Chiba, Japan) in February 2011. The rates of in-hospital mortality and unexpected events before and after introduction of the medical emergency team system were compared. The total number of medical emergency team activation calls was 83 (4.9 per 1,000 admissions). The activation of the medical emergency team system was requested most frequently from the general ward (56.6%) and by a physician (57.8%), with the most important reasons for activation being cardiac arrest (37.3%), breathing abnormality (33.7%), and impaired consciousness (32.5%). The most frequent medical interventions by the medical emergency team were intubation (43.3%) and oxygen inhalation (41.0%). Approximately one-half of the patients requiring activation of the medical emergency team system were critically ill and needed subsequent intensive care unit admission. Although no significant difference was observed between the pre- and post- medical emergency team in-hospital mortalities (2.1% versus 2.0%, respectively), the incidence rate of serious events significantly decreased (12.4% versus 6.8%, respectively; P = 0.015). Most patients requiring activation of the medical emergency team system were critically ill and needed emergency treatment at the location of the medical emergency team activation, with subsequent critical care. Although the introduction of the medical emergency team system did not affect the in-hospital mortality rate, it reduced the incidence of unexpected serious adverse events, suggesting that it may be clinically useful.

Intensive care without walls - introduction of a Medical Emergency Team system in a Swiss tertiary care centre.

To improve the response of deteriorating patients during their hospital stay, the University Hospital Bern has introduced a Medical Emergency Team (MET). Aim of this retrospective cohort study is to review the preceding factors, patient characteristics, process parameters and their correlation to patient outcomes of MET calls since the introduction of the team. Data on patient characteristics, parameters related to MET activation and intervention and patient outcomes were evaluated. A Vital Sign Score (VSS), which is defined as the sum of the occurrence of each vital sign abnormalities, was calculated for all physiological parameters pre MET event, during event and correlation with hospital outcomes. A total of 1,628 MET calls in 1,317 patients occurred; 262 (19.9%) of patients with MET calls during their hospital stay died. The VSS pre MET event (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.50-2.13; AUROC 0.63; all p <0.0001) and during the MET call (OR 1.60, 95% CI 1.41-1.83; AUROC 0.62; all p <0.0001) were significantly correlated to patient outcomes. A significant increase in MET calls from 5.2 to 16.5 per 1000 hospital admissions (p <0.0001) and a decrease in cardiac arrest calls in the MET perimeter from 1.6 in 2008 to 0.8 per 1000 admissions was observed during the study period (p = 0.014). The VSS is a significant predictor of mortality in patients assessed by the MET. Increasing MET utilisation coincided with a decrease in cardiac arrest calls in the MET perimeter.

To reach out or not: is critical care outreach as valuable as it seems?

British Journal of Hospital MedicineVol. 74, No. 7 Anaesthetic and Critical Care DilemmaTo reach out or not: is critical care outreach as valuable as it seems?Simon LambdenSimon LambdenSearch for more papers by this authorSimon LambdenPublished Online:27 Sep 2013https://doi.org/10.12968/hmed.2013.74.7.418AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Athifa M, Finn J, BrearleyLet al. (2011) A qualitative exploration of nurse's perception of Critical Outreach Service: A before and after study. Aust Crit Care 24(1): 39–47 Crossref, Medline, Google ScholarGao H, Harrison DA, Parry GJ, Daly K, Subbe CP, Rowan K (2007) The impact of the introduction of CCOS in England: a multicentre interrupted time series analysis. Crit Care 11: R113 Crossref, Medline, Google ScholarHarrison D, Gao H, Welch CA, Rowan KM (2010) The effects of critical care outreach services before and after critical care: a matched cohort analysis. J Crit Care25: 196–204 Crossref, Medline, Google ScholarHillman K, Chen J, Cretikos M et al.; MERIT study investigators (2005) Introduction of the medical emergency team system: a cluster randomised controlled trial. The Lancet 365: 2091–7 Crossref, Medline, Google ScholarMcGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M (2007) Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev 3: CD005529 Medline, Google ScholarNational Institute for Health and Clinical Excellence (2007) Recognition of and response to acute illness in adults in hospital. CG50. National Institute for Health and Clinical Excellence, London Google Scholar FiguresReferencesRelatedDetails 1 July 2013Volume 74Issue 7ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 27 September 2013 Published in print 1 July 2013 Information© MA Healthcare LimitedPDF download

Multidisciplinary Medical Emergency Team System increases survival in cancer patients undergoing cardiopulmonary resuscitation

In the last years, ICU admission has been high in cancer patients due to increased survival related to advances in treatment. Patients with cancer reportedly have poor outcomes from cardiopulmonary resuscitation (CPR). The goal of this study was to evaluate the effectiveness of a multidisciplinary Medical Emergency Team System in the CPR outcomes in cancer patients.

Evaluation of incoming calls to intensive care unit for emergency assistance

Abstract Aim. The aim of this retrospective study was to determine mean admission time after calls, resuscitation success rate, and determine the rate of medical emergency team (MET) calls of clinics in hospital by assessing the incoming calls to MET at intensive care unit. Methods. This study was conducted by collecting emergency call forms of 147 patients. The data including age, gender, medical diagnosis, the name of the caller department, cause of call, occurrence time, call time, attending time, medical care termination time and the outcomes were extracted from the forms or patient files. Event declaration time was accepted as minute time difference between occurrence time and call time. Duration of admission was accepted as minute time difference between call times and attending time. Duration of resuscitation was accepted as minute time difference between attending time and medical care termination time. Results. Mean event declaration time was 3.3 ± 3.0 minutes. Mean duration of admission was 3.7 ± 1.6 minutes. Mean duration of resuscitation was 20.5 ± 12.7 minutes. The resuscitation of 84 patients (63.6%) was successful while 48 patients (36.4%) died at the end of resuscitation. It was found that the patients with a result of successful resuscitation were significantly younger and their duration of resuscitation was significantly shorter. Conclusion. We indicate that MET system is an essential part of in-hospital emergency medical care system. We suggest that a blue code call system should be established by intensive care unit members and announced to all hospital staff. Keywords: Emergency medical care, medical emergency team, cardiac arrest, blue code, call Ozet Amac. Bu retrospektif calismanin amaci hastane icinde yogun bakim unitemizdeki acil yardim ekibine yapilan cagrilari degerlendirerek, ortalama varis suresi, resusitasyon basari oranlari ve arayan kliniklerin belirlenmesidir. Yontem. Bu calisma 147 hastanin formlari incelenerek yapildi. Yas, cinsiyet, tani, klinik adi, cagri nedeni, olay zamani, arama zamani, varis zamani, tibbi bakim sonlandirma zamani ve sonuc bilgileri kaydedildi. Olay bildirim suresi, varis suresi, resusitasyon suresi bilgileri hesaplanarak kaydedildi. Olay bildirim suresi olay zamani ile arama zamani arasi, varis suresi arama zamani ila varis zamani arasi, resusitasyon suresi varis zamani ile tedaviyi sonlandirma zamani arasi sureler olarak alindi. Bulgular. Ortalama olay bildirim suresi 3,3 ± 3,0 dakika idi. Ortalama varis suresi 3,7 ± 1,6 dakika idi. Ortalama resusitasyon suresi 20,5 ± 12,7 dakika idi. 84 (%63,6) hastanin resusitasyonu basarili iken 48 (%36,4) i resusitasyon sonunda mortaliteyle sonuclandi. Sonuclari basarili olan hastalarin yaslari belirgin olarak daha genc olarak bulundu ve resusitasyon sureleri de belirgin olarak dusuktu. Sonuc. Acil yardim ekibinin hastane ici acil durumlar icin onemli oldugunu belirtmekteyiz. Bir mavi kod cagri sisteminin yogun bakim uyeleri tarafindan olusturularak tum hastaneye bildirilmesi gerektigi kanaatindeyiz. Anahtar sozcukler: Acil tibbi bakim, acil yardim ekibi, kardiak arrest, mavi kod, cagri

Expansion of a medical emergency team system to a mental health facility

BackgroundClinical emergency response systems such as medical emergency teams (MET) are used in many hospitals worldwide, but the effect that these systems have in mental health facilities is unknown. This study examined the rate and nature of MET calls to a mental health facility that had relocated to the campus of a tertiary referral hospital. MethodsThis study was a prospective, observational study of MET calls to a newly constructed 170 bed mental health facility. Data were collected on the number and nature of MET calls to the facility. ResultsOver 24 months, there were 66 MET calls to the mental health facility, and 1217 MET calls at the main hospital. The mean MET call rate was 14.2 calls per 1000 admissions (95% confidence interval (CI) 10.8–17.7) at the mental health facility, and 14.7 calls per 1000 admissions (95% CI 13.9–15.5) at the main hospital. Neurological and cardiovascular problems were present in 61% and 41% of MET calls. ConclusionThe rate of MET calls to a new mental health facility can be similar to that of a tertiary hospital. Staff attending MET calls need to be prepared to manage predominantly neurological and cardiovascular problems.

Level of agreement on resuscitation decisions among hospital specialists and barriers to documenting do not attempt resuscitation (DNAR) orders in ward patients

AimThis study assessed the level of agreement on CPR decisions among intensive care doctors and specialist physicians and surgeons, and the barriers to documenting do not attempt resuscitation (DNAR) orders for ward patients during Medical Emergency Team (MET) calls. MethodsWe prospectively assessed all patients having MET calls for 11 months. If the intensive care doctor on the MET considered a DNAR order appropriate for the patient, the primary care clinician was contacted to: (1) confirm agreement or disagreement with a DNAR order and (2) give reasons as to why a DNAR order was not considered or documented prior to the MET call. ResultsIn the study period, the MET attended 1458 patients. A DNAR order was considered appropriate in 129 cases. In 116 (90%), the primary care clinician agreed with a DNAR order at the time of the MET. Common reasons given by primary care clinicians for not documenting DNAR orders included acute or unexpected deterioration (22.5%), awaiting family discussion (22.5%), actively treating the patient for a reversible condition (17.1%), not knowing the patient well enough (10.9%) and resuscitation status not yet discussed by team (10.9%). ConclusionsThis study shows a high level of agreement on DNAR orders among intensive care doctors, physicians and surgeons for deteriorating ward patients. Barriers to timely documentation need to be addressed. Delay in documentation and communication of DNAR orders is common. The MET system provides an opportunity to identify patients for whom a DNAR order should be considered.

Peri-operative medical emergency team activation in liver transplantation

BackgroundThe medical emergency team (MET) system functions to promptly identify acutely ill patients at-risk for deterioration. Liver transplant (LT) patients are at-risk for serious post-operative complications.ObjectiveTo evaluate the characteristics of...

Attitudes and barriers to a Medical Emergency Team system at a tertiary paediatric hospital

Aim To determine the attitudes and barriers to an established paediatric Medical Emergency Team (MET) system among nurses and doctors. Methods Invitation to all clinical staff in a paediatric hospital to complete an electronic 41-item branched survey. Responses were graded on a Likert scale. Results 407 staff completed the survey (280 nurses, 127 doctors). The MET system was highly valued for obtaining urgent assistance for the seriously ill patients by 85% of nurses and 83% of doctors. However, barriers to MET activation included; preference to contact the covering (attending) doctors by 80% of nurses and 45% of doctors, active discouragement to activating a MET by 41% of nurses and 12% of doctors, and fear of criticism by 17% of nurses and 9% of doctors if the patient was not deemed seriously ill by the MET attendees. Less experienced staff were significantly more likely to report barriers to calling a MET. Negative attitudes from MET attendees were reported by nurses (24%) and doctors (6.5%). Failure to recognize serious illness was revealed by unwillingness of 47% of doctors and 32% of nurses to activate MET when activation criteria were attained and by retrospective realization by 30% of doctors and 15% of nurses that they had failed to activate MET when needed. Conclusions Cultural and behavioral barriers to MET activation and inability to recognize serious illness may explain in part the failure of a MET system to completely eliminate unexpected cardiac arrest and death. Unless these issues are addressed, the full benefits of a MET system may not be realised.

Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

Part 5: Adult basic life support: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

Triggers for emergency team activation: A multicenter assessment

Purpose The purpose of the study was to examine triggers for emergency team activation in hospitals with or without a medical emergency team (MET) system. Materials and Methods Within a cluster randomized controlled trial examining the effect of introducing a MET system, we recorded the triggers for emergency team activation. We compared the proportion and rate of such triggers in hospitals with or without a MET system and in relation to type of hospital, type of patient ward, and time of day. Results In control hospitals, the most common trigger for emergency team activation was a decrease in Glasgow Coma Score by 2 or more points (45.6%), whereas in MET hospitals, it was the fact that staff members were “worried” or the call occurred despite the lack of a “specified reason” (39.3%). In particular, MET hospitals were 35 times more likely to make a call because of staff being “worried” about the patient (14.1% vs 0.4%, P < .001). Control hospitals were also significantly more likely to call an emergency team because of a deteriorating respiratory ( P = .003) or pulse ( P < .001) rate, more calls had at least 3 triggers for activation (20.8% vs 10.2%, P = .036), and the average number of triggers per call was significantly higher ( P = .013). Nonmetropolitan hospitals were more likely to call an emergency team because of respiratory rate abnormalities (33.6% vs 23.2%, P = .015). Coronary care unit calls were more likely to be triggered by abnormalities in pulse rate and systolic blood pressure, and more calls occurred during the period from 6:00 am to noon. Conclusions In MET hospitals, more emergency team calls are triggered because staff members are worried about the patient; and fewer calls have multiple triggers. Type of hospital, type of ward, and time of day also affect the nature and frequency of triggers for emergency team activation.