Triggers for emergency team activation: A multicenter assessment☆,☆☆
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
References (28)
- et al.
A clinical model for health services research—the medical emergency team
J Crit Care
(2003) - et al.
Redefining in-hospital resuscitation: the concept of the medical emergency team
Resuscitation
(2001) - et al.
Using a medical emergency team to manage anaphylactic shock
Jt Comm J Qual Patient Saf
(2008) - et al.
Regulation of extra hospital delivery and pre hospital care by the emergency medical care coordinator
Urgences Medicales
(1996) - et al.
The medical emergency team: 12 month analysis of reasons for activation, immediate outcome and not-for-resuscitation orders
Resuscitation
(2001) - et al.
The medical emergency team system: a two hospital comparison
Resuscitation
(2008) - et al.
Analysis of medical emergency team calls comparing subjective to “objective” call criteria
Resuscitation
(2009) - et al.
The medical emergency team and end-of-life care: a pilot study
Crit Care Resusc
(2007) - et al.
Use of medical emergency team (MET) responses to detect medical errors
Qual Saf Health Care
(2004) - et al.
The medical emergency team
Anaesth Intensive Care
(1995)
Medical emergency team: a review of the literature
Nurs Crit Care
Condition HELP: a paediatric rapid response team triggered by patients and parents
J Healthc Qual
Characteristics and outcomes of patients receiving a medical emergency team review for acute change in conscious state or arrhythmias
Crit Care Med
Transition from a traditional code team to a medical emergency team and categorization of cardiopulmonary arrests in a children's center
Arch Pediatr Adolesc Med
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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.
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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.