Delayed Medical Emergency Team Calls and Associated Outcomes*

Boniatti, Márcio Manozzo; Azzolini, Neusa; Viana, Marina Verçoza; Ribeiro, Berenice S. P.; Coelho, Renata Souza; Castilho, Rodrigo Kappel; Guimarães, Márcio R.; Zorzi, Lia A.; Schulz, Luis Fernando; Filho, Édison Moraes Rodrigues

doi:10.1097/ccm.0b013e31829e53b9

Cited by 118 publications

(103 citation statements)

References 26 publications

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“…23 It is pivotal to disengage these afferent limb failures. [12][13][14][15] Regardless of the fact that in our study these antecedents were not independently associated with worse outcome, some IHCAs could have been avoided either by appropriate interventions or ethically sound treatment limitations.…”

Section: Discussionmentioning

confidence: 49%

“…Fourth, the time frame of 20-720 min for preceding vital dysfunctions and subjective antecedents simplifies deteriorations of different durations, although it enables feasible utilization of these factors in multivariate logistic regression model and this same methodology is used in MET studies. [12][13][14][15] These limitations should be weighed against the strengths of this study. Aetiology was determined by autopsy for 55% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…12-15 Our hospital's objective MET criteria are presented in Table 3. Because the time period considered to be incorporated in ALF analysis is very disperse (starting from 15-60 min before the event and ending at 420-1440 min before the event), [12][13][14][15] we defined the time frame in this study to be 20-720 min. Definitions for subjective symptoms preceding IHCAs (antecedents) are also presented in Table 3.…”

Section: Definitionsmentioning

confidence: 99%

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Aetiology of in-hospital cardiac arrest on general wards

et al. 2016

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a b s t r a c tAim: Aetiology of in-hospital cardiac arrests (IHCAs) on general wards has not been studied. We aimed to determine the underlying causes for IHCAs by the means of autopsy records and clinical judgement of the treating consultants. Furthermore, we investigated whether aetiology and preceding vital dysfunctions are associated with long-term survival. Design and setting: Prospective observational study between 2009-2011 including 279 adult IHCA patients attended by medical emergency team in a Finnish university hospital's general wards. Results: The median age of the patients was 72 (64, 80) years, 185 (66%) were male, 178 (64%) of events were monitored/witnessed, first rhythm was shockable in 42 (15%) cases and 53 (19%) patients survived six months. Aetiology was determined as cardiac in 141 events, 73 of which were due to acute myocardial infarction. There were 138 non-cardiac IHCAs; most common causes were pneumonia (39) and exsanguination (16). No statistical difference was observed in the incidence of objective vital dysfunctions preceding the event between the cardiac and non-cardiac groups (40% vs. 44%, p = 0.448). Subjective antecedents were more common in the cardiac cohort (47% vs. 32%, p = 0.022), chest pain being an example (11% vs. 0.7%, p < 0.001). Reviewing all 279 IHCAs, only shockable primary rhythm, monitored/witnessed event and low comorbidity score were independently associated with 180-day survival. Conclusions: Cardiac aetiology underlies half of the IHCAs on general wards. Both objective and subjective antecedents are common. However, neither the cardiac aetiology nor the absence of preceding deterioration of vital signs were factors independently associated with a favourable outcome.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 99%

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Aetiology of in-hospital cardiac arrest on general wards

et al. 2016

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“…Failure to recognise or effectively respond to deteriorating patients remains problematic both nationally and internationally (Boniatti et al, 2014;Fuhrmann, Lippert, Perner, & Østergaard, 2008). Associated factors are multifactorial but are largely attributed to an inadequate interpretation of changes in the patient's condition in conjunction with failure to implement the appropriate escalation action (DeVita et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

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

Guinane

Hutchinson

Bucknall

2018

Journal of Clinical Nursing

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“…We conducted a comprehensive review of English language articles using the term "rapid response team" or "medical emergency team" and "palliative care, " "end-of-life care, " "limitation of medical treatment [or life support], " "do not resuscitate, " "not for resuscitation, " "life support, " "advance directive, " "goals of care, " or "symptom. " Based on this literature and the experiences of our interdisciplinary advisory board, we focus on the following questions: (1) What are special challenges for the provision of palliative care by a rapid response team? (2) What knowledge and skills are needed to support the delivery of high-quality palliative care in the rapid response setting?…”

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confidence: 99%

Integration of Palliative Care in the Context of Rapid Response

Nelson

Mathews

Weissman

et al. 2015

Chest

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on behalf of The Improving Palliative Care in the ICU Project Advisory BoardRapid response teams (RRTs) can eff ectively foster discussions about appropriate goals of care and address other emergent palliative care needs of patients and families facing lifethreatening illness on hospital wards. In this article, The Improving Palliative Care in the ICU (IPAL-ICU) Project brings together interdisciplinary expertise and existing data to address the following: special challenges for providing palliative care in the rapid response setting, knowledge and skills needed by RRTs for delivery of high-quality palliative care, and strategies for improving the integration of palliative care with rapid response critical care. We discuss key components of communication with patients, families, and primary clinicians to develop a goal-directed treatment approach during a rapid response event. We also highlight the need for RRT expertise to initiate symptom relief. Strategies including specifi c clinician training and system initiatives are then recommended for RRT care improvement. We conclude by suggesting that as evaluation of their impact on other outcomes continues, performance by RRTs in meeting palliative care needs of patients and families should also be measured and improved.

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Delayed Medical Emergency Team Calls and Associated Outcomes*

Abstract: Delayed medical emergency team calls are common and are independently associated with higher mortality. This result reaffirms the concept and need for a rapid response system.

Cited by 118 publications

References 26 publications

Aetiology of in-hospital cardiac arrest on general wards

Aetiology of in-hospital cardiac arrest on general wards

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

Integration of Palliative Care in the Context of Rapid Response

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