Use Of Medical Emergency Teams Research Articles

Pediatric intraoperative cardiopulmonary arrests: A survey to evaluate if Medical Emergency Teams are utilized in pediatric operating rooms.

Studies have shown that standardized code teams may improve outcomes following cardiac arrests. Pediatric intra-operative cardiac arrests are rare events and are associated with a mortality rate of 18%. There is limited data available regarding use Medical Emergency Team (MET) response to pediatric intra-operative cardiac arrest. The purpose of this study was to identify the use of MET in response to pediatric intraoperative cardiac arrest as an exploratory step in establishing evidence-based standardized practice across the hospital for training and management of this rare event. An anonymous electronic survey was created and sent to two populations: The Pediatric Anesthesia Leadership Council, a section of the Society for Pediatric Anesthesia, and the Pediatric Resuscitation Quality Collaborative, a multinational collaborative group, which works to improve resuscitation care in children. Standard summary and descriptive statistics were used for survey responses. The overall response rate was 41%. The majority of respondents worked in a university affiliated, free-standing children's hospital. Ninety-five percent of respondents had a dedicated pediatric MET at their hospital. In 60% of responses from Pediatric Resuscitation Quality Collaborative and 18% of Pediatric Anesthesia Leadership Council hospitals, the MET responds to pediatric intra-operative cardiac arrest; however, the majority of times MET involvement is requested rather than automatic. The MET was found to be activated intraoperatively for situations other than cardiac arrest such as, massive transfusion events, need for extra staff, and for specialty expertise. In 65% of institutions, simulation-based training for cardiac arrest is supported but lacking pediatric intra-operative focus. This survey revealed heterogeneity in the composition and response of the medical response teams responding to pediatric intra-operative cardiac arrests. Improved collaboration and cross training among MET, anesthesia, and operating room nursing may improve outcomes of pediatric intra-operative code events.

Impact of professionalism in nursing on in‐hospital bedside monitoring practice

This article reports a study exploring nursing practice of monitoring in-hospital patients including intra- and interprofessional communication and collaboration. Sub-optimal care in general in-hospital wards may lead to admission for intensive care, cardiac arrest, or sudden death. Reasons may include infrequent measurements of vital parameters, insufficient knowledge of their predictive values, and/or sub-optimal use of Medical Emergency Teams. This study was designed to improve understanding of nursing practice and to identify changes required to support nursing staff in improving standards of clinical monitoring practice and patient safety in general in-hospital wards. The study was designed as a qualitative descriptive clinical study, based on method triangulation including structured individual observations and semi-structured individual interviews. In the spring of 2009, structured observations and semi-structured interviews of 13 nurses were carried out at a university hospital in Copenhagen, Denmark. The observational notes and interview transcriptions were analysed using content analysis. One theme (Professionalism influences nursing monitoring practice) and two sub-themes (Knowledge and skills and Involvement in clinical practice through reflections) were identified. Three categories (Decision-making, Sharing of knowledge, and Intra- and interprofessional interaction) were found to be associated with the theme, the sub-themes, and with each other. Clinical monitoring practice varies considerably between nurses with different individual levels of professionalism. Future initiatives to improve patient safety by further developing professionalism among nurses need to embrace individual and organizational attributes to strengthen their practice of in-hospital patient monitoring and management.

Characteristics of hospital nursing staff and patient outcomes: A commentary on Twigg et al (2010)

The study of the effect of hospital nurse staffing characteristics on patient morbidity and mortality by Twigg et al. (2010) hasmany strengths, including very high sample size and sophisticated statistical analysis. However, due to weaknesses that are not fully addressed in the study, the principal conclusion is not at all supported by the study findings. The conclusions are also self-contradictory, as explained below. First, the study concluded that the findings provide evidence that supports the NHPPD staffing method. The NHPPD staffing method was not studied though; the sum of the nursing hours was studied irrespective of whether the nursing hours had the pattern of the NHPPD formula. Consequently, the only conclusion that can be drawn from the findings is that increased nursing hours are associated with improved patient outcomes, and not the NHPPD formula. To determine the conclusion above, hospitals that increase nursing levels by a formula other than NHPPD would need to be compared with those that increase it by NHPPD, and of course, this was not the structure of this study. Second, the study concluded that this evidence must influence policy regarding nurse staffing levels. This is not consistent with their statement that the findings only provide evidence or add evidence that supports NHPPD staffing levels. In other words, it appears that the assumption is made that if you find any evidence for something, then it must be completely and automatically true. Last, the study used a non-experimental design called a time series design rather than an experimental method, and thus suffers from a lack of internal validity, as do all studies of this design. Without a control group or manipulated variable, cause-and-effect cannot be determined nor assumed. Specifically, the authors cannot conclude that the increased nurse staffing levels were the cause of the improved patientmortality andmorbidity. This is readily explained with an example. Suppose that a hospital has a lower patientmortality in 2009 than in 2008. If that hospital also put up more pictures of flowers in the hallways of the hospital in 2009 than in 2008, a statistical analysis of the type used in this study would find a strong association between the number of pictures and the death rate. If the same logic was used as in the above study, the conclusion would be that a policy must be established to require more flower pictures in hospitals everywhere. Although this argument seems absurd when expressed in this manner, in that it seems self-evident that increased nursing hours should be beneficial, if it was self-evident, studies would not need to be done on this question. This study is actually one case of a widespread problem in the hospital research, most of which uses non experimental designs. Improvement in patient outcomes have been attributed to multidisciplinary communication (Vazirani et al., 2005), use of medical emergency teams (Bellomo et al., 2003), type and frequency of rounds (Dutton et al., 2003), early identification and treatment of International Journal of Nursing Studies 48 (2011) 655–656

The use of medical emergency teams in medical and surgical patients: impact of patient, nurse and organisational characteristics

Medical emergency teams (METs) were developed to respond more rapidly to changes in patient condition. While effective, METs do not address events prior to the response. This study examined differences...

GS14P ROUTINE USE OF MEDICAL EMERGENCY TEAMS IN MANAGING SURGICAL EMERGENCIES

Introduction Trauma teams and cardiac arrest teams provide an urgent and expert multi‐disciplinary response to time critical emergencies. The present study documents the contribution of a medical emergency team (MET) to managing non‐trauma surgical emergencies.Materials and Methods Data was prospectively collected over a two year period concerning the contribution of medical emergency teams to the resuscitation of all patients with non‐trauma surgical emergencies and altered vital signs in hospital wards.Results Over the study period, the details of 19 patients with surgical emergencies were recorded. 63% of emergencies occurred outside of normal working hours. In 53% of cases, the surgical registrar was off‐site or physically unavailable to attend the emergency immediately. In 11% of cases, the medical emergency team was activated prior to the arrival of the surgical registrar. In 26% of cases, the patient was left unattended whilst awaiting arrival of the surgical registrar. The medical emergency team provided resuscitation procedures and arranged urgent investigations in all patients, physically transported the patient to the operating theatre in 16% of patients and prepared for general anaesthetic in the operating theatre in 11% of cases. The surgical registrar complemented the medical emergency team response by liaising with consultant surgeons, anaesthetists and operating theatre staff in all cases. All patients received definitive treatment within 30 minutes of MET response.Conclusion Routine use of medical emergency teams in the initial resuscitation of patients with surgical emergencies expedites definitive management.

Do surgeons need to look after unwell patients? The role of medical emergency teams

Medical emergency teams (MET) have been shown to reduce in-hospital morbidity and mortality of surgical patients. The present study reviews the experience with the use of MET in the care of critically unwell surgical patients. Data were prospectively collected on all patients in a general surgical unit of a tertiary referral centre meeting the criteria for activating a MET over a 6 month period. These data were retrospectively analysed with respect to surgical team and MET involvement in the care of these patients. Over the 6 month study period, 22 patients qualified for a MET response based on criteria of physiological instability. A MET was activated for 13 of these patients (59%), with the remainder being managed by direct consultation with intensive care and medical staff. Forty-six per cent of MET activations were outside of normal working hours. Respiratory distress including tachypnoea and desaturation was the most commonly identified physiological abnormality (13 patients), accounting for 62% of MET activations. A MET was activated by a surgical registrar in 46% of cases. Seventy-seven per cent of MET activations were preceded by at least one registrar level assessment without resolution of the patient's clinical deterioration. The most common MET interventions were supplementation of oxygen therapy and initiation of pharmacotherapy (11 patients). The surgical team complemented the MET response by providing detailed information regarding the patient's surgical condition, premorbid status (13 patients), organized transfer to the operating theatre (three patients), initiated blood transfusions (two patients) and deciding to order abdominal computed tomography (two patients). Urgent surgical decision making was required in 23% of MET activations. Medical emergency team activations for critically unwell surgical patients are complemented by surgical team involvement in the decision making and management process. The MET may be underutilized in the management of unwell surgical patients.

Use of medical emergency team responses to reduce hospital cardiopulmonary arrests.

Medical emergency team (MET) responses have been implemented to reduce inpatient mortality, but data on their efficacy are sparse and there have been no reports to date from US hospitals. To determine how the incidence and outcomes of cardiac arrests have changed following increased use of MET. Objective criteria for MET activation were created and disseminated as part of a crisis management program, after which there was a rapid and sustained increase in the use of MET. A retrospective analysis of clinical outcomes was performed to compare the incidence and mortality of cardiopulmonary arrest before and after the increased use of MET. A retrospective analysis of 3269 MET responses and 1220 cardiopulmonary arrests over 6.8 years showed an increase in MET responses from 13.7 to 25.8 per 1000 admissions (p<0.0001) after instituting objective activation criteria. There was a coincident 17% decrease in the incidence of cardiopulmonary arrests from 6.5 to 5.4 per 1000 admissions (p = 0.016). The proportion of fatal arrests was similar before and after the increase in use of MET. Increased use of MET may be associated with fewer cardiopulmonary arrests.

Use of medical emergency team (MET) responses to detect medical errors.

No previous studies have investigated whether medical emergency team (MET) responses can be used to detect medical errors. To determine whether review of MET responses can be used as a surveillance method for detecting medical errors. Charts of all patients receiving MET responses during an 8 month period were reviewed by a hospital based Quality Improvement Committee to establish if the clinical deterioration that prompted the MET response was associated with a medical error (defined as an adverse event that was preventable with the current state of medical knowledge). Medical errors were categorized as diagnostic, treatment, or preventive errors using a descriptive typology based on previous published reports. Three hundred and sixty four consecutive MET responses underwent chart review and 114 (31.3%) were associated with medical errors: 77 (67.5%) were categorized as diagnostic errors, 68 (59.6%) as treatment errors, and 30 (26.3%) as prevention errors. Eighteen separate hospital care processes were identified and modified as a result of this review, 10 of which involved standardization. MET review may be used for surveillance to detect medical errors and to identify and modify processes of care that underlie those errors.