Elsevier

Journal of Critical Care

Volume 25, Issue 2, June 2010, Pages 359.e1-359.e7
Journal of Critical Care

Triggers for emergency team activation: A multicenter assessment,☆☆

https://doi.org/10.1016/j.jcrc.2009.12.011Get rights and content

Abstract

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.

Introduction

Medical emergency team (MET) or rapid response team (RRT) systems have been developed with the aim of recognizing seriously ill hospital patients early and, thereby, reducing adverse events through early intervention [1], [2], [3], [4]. These systems have now been widely adopted internationally [5], [6], [7], [8]. They have been extended to cover pediatric [7], [9], [10], [11], [12], obstetric [13], [14], [15], and emergency department patients [16], [17], [18], [19]. Within these systems, nursing and/or medical staff can call an emergency team based on prespecified vital sign abnormalities (“triggers”) or because they believe the patient is at risk of a serious adverse event (“worried” criterion). However, there is limited information concerning the nature and frequency of the calling criteria used to activate an emergency response. In particular, there is no information as to whether the introduction of a MET system affects the nature, frequency, and timing of such triggers and whether type of hospital, type of ward, and time of day also affect them. Such information is important in helping understand how these systems affect care and where there may be deficiencies. In this study, we used the data from a 23-hospital cluster randomized controlled trial of the introduction of a MET system (the Medical Early Response Intervention Therapy [MERIT] study) [20] to test the hypotheses that the presence of a MET system, the type of hospital, the type of ward, and the time of day would affect the triggers responsible for emergency team activation.

Section snippets

Methods

The sample recruitment, size calculation, ethical approval, and randomization scheme for the MERIT study have been described previously [20]. The 23 hospitals were randomized to introduction of a MET system or to a control group. Data collection was conducted during a 2-month baseline period, followed by a 4-month standardized implementation period and a further 6-month study period during which the MET system was operational. Data were collected from both MET and control hospitals throughout

Statistical methods

To take hospital-specific effects into account, we conducted cluster-specific analyses. For descriptive analyses, the means and proportions were presented; and standard errors were adjusted for cluster effect where appropriate. To test the association between categorical variables, the Rao-Scott χ2 test or survey-adjusted logistic regression was used where appropriate. For continuous variables, the survey-adjusted t test was used to test the difference between 2 groups. The survey-adjusted

Reasons for triggering calls in the MET and control hospitals

In control hospitals, a decrease in GCS by 2 or more points (45.6%) was the single most common trigger for emergency team activation, followed by abnormalities in pulse rate (34.8%) or respiratory rate (33.1%) (Table 1). Either being “worried” or “not specified” accounted for 30.5% of all triggers. On the other hand, in MET hospitals, being “worried” or “not specified” were the commonest trigger (39.3%), followed by a decrease in GCS (32.1%) and abnormalities in respiratory rate or pulse rate

Discussion

Using the data from the MERIT study, we examined the nature and frequency of triggers for emergency team activation in hospitals with or without a MET system. We found that MET hospitals had a significantly higher number and percentage of calls due to nurses or physicians being ”worried” about the patient or for “not specified” reasons. On the other hand, in control hospitals, more of the calls were due to a specific physiologic trigger (with GCS being most common), more calls were triggered by

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    The MERIT study is a collaboration of the Simpson Centre for Health Services Research and the Australian and New Zealand Intensive Care Society Clinical Trials Group.

    ☆☆

    Sources of support for the study: The study was funded by grants from the National Health and Medical Research Council of Australia, the Australian Council for Safety and Quality in Health Care, and the Australian and New Zealand Intensive Care Foundation as part of the MERIT study.

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