Findings of the First Consensus Conference on Medical Emergency Teams*

DeVita, Michael A.; Bellomo, Rinaldo; Hillman, Kenneth; Kellum, John A.; Rotondi, Armando J.; Teres, Dan; Auerbach, Andrew D.; Chen, Wen-Jon; Duncan, Kathleen; Kenward, Gary; Bell, Max; Buist, Michael; Chen, Jack; Bion, Julian; Kirby, Ann; Lighthall, Geoffrey K.; Ovreveit, John; Braithwaite, R. Scott; Gosbee, John; Milbrandt, Eric B; Peberdy, Mimi A; Savitz, Lucy A.; Young, Lis; Galhotra, Sanjay

doi:10.1097/01.ccm.0000235743.38172.6e

Cited by 733 publications

(608 citation statements)

References 11 publications

Supporting

Mentioning

559

Contrasting

Unclassified

Order By: Relevance

“…On the basis of RRS features in widely cited articles [22][23][24] and the recommendations of a recent consensus statement, 5 we defined an RRS as having the following characteristics: (1) its primary responsibility is to intervene whenever hospitalized patients become unstable before cardiopulmonary arrest occurs; (2) it must primarily provide care outside the ICU and emergency department; (3) specific clinical criteria must be in place that define instability and trigger a call to the team; and (4) it must be expected to respond within a specified time. We defined these criteria in order to distinguish studies of RRSs from studies of cardiac arrest ("code blue") teams or traditional consulting services.…”

Section: Literature Search and Inclusion And Exclusion Criteriamentioning

confidence: 99%

“…On the basis of recommendations for the assessment of methodology for nonrandomized study designs, 25,26 we identified and abstracted 4 important determinants of internal validity ( Table 1). The consensus statement 5 recommends monitoring the effectiveness of RRSs by measuring the rate of unscheduled ICU admissions (defined as an unplanned admission to the ICU from a general ward 27 ) and cardiac arrests of patients who were not listed as "do not resuscitate" (DNR). As the definition of unscheduled ICU admission allows room for subjectivity, we considered the blinding of assessment of this outcome to study group assignment to be important, especially for retrospective studies.…”

Section: Example Of Rapid Response System Calling Criteria For Adultmentioning

confidence: 99%

“…Equivalent terms used are rapid response team, 2 critical care outreach team, 3 and patient-at-risk team. 4 A consensus panel 5 recently endorsed use of the term rapid response system (RRS) to denote any system that uses a standard set of clinical criteria to summon caregivers to the bedside of a patient who is deemed unstable but not in cardiopulmonary arrest (in which case a standard resuscitation team would be summoned). Such teams primarily evaluate patients on general hospital wards.…”

mentioning

confidence: 99%

“…The structure of RRSs varies but generally includes a physician and nurse and may also include other staff such as respiratory therapists. 5 Teams are summoned by hospital staff to assess patients meeting specific clinical criteria (see box) about whom the bedside staff has significant concern. 15 Initial studies of RRSs, performed primarily in Australia and the United Kingdom, showed promising reductions in unanticipated ICU admissions, cardiac arrests, and even overall inpatient mortality.…”

mentioning

confidence: 99%

See 3 more Smart Citations

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Ranji

Auerbach

Hurd

et al. 2007

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUNDA rapid response system (RRS) consists of providers who immediately assess and treat unstable hospitalized patients. Examples include medical emergency teams and rapid response teams. Early reports of major improvements in patient outcomes led to widespread utilization of RRSs, despite the negative results of a subsequent cluster‐randomized trial.PURPOSETo evaluate the effects of RRSs on clinical outcomes through a systematic literature review.DATA SOURCESMEDLINE, BIOSIS, and CINAHL searches through August 2006, review of conference proceedings and article bibliographies.STUDY SELECTIONRandomized and nonrandomized controlled trials, interrupted time series, and before‐after studies reporting effects of an RRS on inpatient mortality, cardiopulmonary arrests, or unscheduled ICU admissions.DATA EXTRACTIONTwo authors independently determined study eligibility, abstracted data, and classified study quality.DATA SYNTHESISThirteen studies met inclusion criteria: 1 cluster‐randomized controlled trial (RCT), 1 interrupted time series, and 11 before‐after studies. The RCT showed no effects on any clinical outcome. Before‐after studies showed reductions in inpatient mortality (RR = 0.82, 95% CI: 0.74‐0.91) and cardiac arrest (RR = 0.73, 95% CI: 0.65‐0.83). However, these studies were of poor methodological quality, and control hospitals in the RCT reported reductions in mortality and cardiac arrest rates comparable to those in the before‐after studies.CONCLUSIONSPublished studies of RRSs have not found consistent improvement in clinical outcomes and have been of poor methodological quality. The positive results of before‐after trials likely reflects secular trends and biased outcome ascertainment, as the improved outcomes they reported were of similar magnitude to those of the control group in the RCT. The effectiveness of the RRS concept remains unproven. Journal of Hospital Medicine 2007;2:422–432. © 2007 Society of Hospital Medicine.

show abstract

Section: Literature Search and Inclusion And Exclusion Criteriamentioning

confidence: 99%

Section: Example Of Rapid Response System Calling Criteria For Adultmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Ranji

Auerbach

Hurd

et al. 2007

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…1 Although numerous studies have examined the clinical impacts of pediatric [2][3][4][5][6][7][8][9][10] and adult 11,12 METs, no studies have evaluated their financial costs and benefits.…”

mentioning

confidence: 99%

Cost-Benefit Analysis of a Medical Emergency Team in a Children’s Hospital

Bonafide

Localio

Song³

et al. 2014

Pediatrics

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT:Numerous studies have demonstrated clinical benefits of medical emergency team (MET) implementation, including reductions in mortality, cardiac arrests, and critical deterioration events. No studies have evaluated the financial costs and benefits of METs. WHAT THIS STUDY ADDS:The costs of operating an MET can plausibly be recouped with a modest reduction in critical deterioration events. Hospitals reimbursed with bundled payments could see real financial savings by reducing critical deterioration events with a MET. abstract OBJECTIVES: Medical emergency teams (METs) can reduce adverse events in hospitalized children. We aimed to model the financial costs and benefits of operating an MET and determine the annual reduction in critical deterioration (CD) events required to offset MET costs. METHODS:We performed a single-center cohort study between July 1, 2007 and March 31, 2012 to determine the cost of CD events (unplanned transfers to the ICU with mechanical ventilation or vasopressors in the 12 hours after transfer) as compared with transfers to the ICU without CD. We then performed a cost-benefit analysis evaluating varying MET compositions and staffing models (freestanding or concurrent responsibilities) on the annual reduction in CD events needed to offset MET costs. RESULTS:Patients who had CD cost $99 773 (95% confidence interval, $69 431 to $130 116; P , .001) more during their post-event hospital stay than transfers to the ICU that did not meet CD criteria. Annual MET operating costs ranged from $287 145 for a nurse and respiratory therapist team with concurrent responsibilities to $2 358 112 for a nurse, respiratory therapist, and ICU attending physician freestanding team. In base-case analysis, a nurse, respiratory therapist, and ICU fellow team with concurrent responsibilities cost $350 698 per year, equivalent to a reduction of 3.5 CD events.CONCLUSIONS: CD is expensive. The costs of operating a MET can plausibly be recouped with a modest reduction in CD events. Hospitals reimbursed with bundled payments could achieve real financial savings by reducing CD with an MET. Pediatrics 2014;134:235-241

show abstract

Defining the Incidence of Cardiorespiratory Instability in Patients in Step-down Units Using an Electronic Integrated Monitoring System

Hravnak¹

2008

Arch Intern Med

113

View full text Add to dashboard Cite

Background: To our knowledge, detection of cardiorespiratory instability using noninvasive monitoring via electronic integrated monitoring systems (IMSs) in intermediate or step-down units (SDUs) has not been described. We undertook this study to characterize respiratory status in an SDU population, to define features of cardiorespiratory instability, and to evaluate an IMS index value that should trigger medical emergency team (MET) activation.Methods: This descriptive, prospective, singleblinded, observational study evaluated all patients in a 24-bed SDU in a university medical center during 8 weeks from November 16, 2006, to January 11, 2007. An IMS (BioSign; OBS Medical, Carmel, Indiana) was inserted into the standard noninvasive hardwired monitoring system and used heart rate, blood pressure, respiratory rate, and peripheral oxygen saturation by pulse oximetry to develop a single neural networked signal, or BioSign Index (BSI). Data were analyzed for cardiorespiratory instability according to BSI trigger value and local MET activation criteria. Staff were blinded to BSI data collected in 326 patients (total census).Results: Data for 18 248 hours of continuous monitoring were captured. Data for peripheral oxygen saturation by pulse oximetry were absent in 30% of monitored hours despite being a standard of care. Cardiorespiratory status in most patients (243 of 326 [74.5%]) was stable throughout their SDU stay, and instability in the remaining patients (83 of 326 [25%]) was exhibited infrequently. We recorded 111 MET activation criteria events caused by cardiorespiratory instability in 59 patients, but MET activation for this cause occurred in only 7 patients. All MET events were detected by BSI in advance (mean, 6.3 hours) in a bimodal distribution (Ͼ6 hours and Յ45 minutes).Conclusions: Cardiorespiratory instability, while uncommon and often unrecognized, was preceded by elevation of the IMS index. Continuous noninvasive monitoring augmented by IMS provides sensitive detection of early instability in patients in SDUs.

show abstract

Findings of the First Consensus Conference on Medical Emergency Teams*

Cited by 733 publications

References 11 publications

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Effects of rapid response systems on clinical outcomes: Systematic review and meta‐analysis

Cost-Benefit Analysis of a Medical Emergency Team in a Children’s Hospital

Defining the Incidence of Cardiorespiratory Instability in Patients in Step-down Units Using an Electronic Integrated Monitoring System

Contact Info

Product

Resources

About