Introduction of medical emergency teams in Australia and New Zealand: a multicentre study

England, Kaye; Bion, Julian

doi:10.1186/cc6902

Cited by 22 publications

(13 citation statements)

References 10 publications

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“…We agree with a previously published statement that evaluating an alreadyestablished practice is as difficult as servicing a car in motion (7). RRT implementation is associated with increased numbers of ICU admissions and rates, and transfer from the ward of less severely ill patients.…”

Section: Discussionsupporting

confidence: 86%

“…The median (IQR) ICU and hospital length of stay were 3 (2-5) and 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days, respectively. The median (IQR) ICU length of stay was slightly longer during the pre-RRT period ( Table 3).…”

Section: Differences Between Transfers During the Pre-rrt And Rrt Permentioning

confidence: 99%

“…In its 2008 National Patient Safety Goals, the Joint Commission suggested a methodology to enable healthcare staff members to directly request additional assistance from other individuals when the patient's condition appears worsening (3). Because the RRT concept is widely accepted in current practice, randomized clinical trials may be difficult at this time (7). Although randomized clinical trials are appropriate to study the effect of a specific drug or procedure, they may not be appropriate to study complex systems such as RRTs.…”

mentioning

confidence: 99%

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The Impact of Rapid Response Team on Outcome of Patients Transferred From the Ward to the ICU

Karpman

Keegan

Jensen

et al. 2013

Critical Care Medicine

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Rapid response team implementation is associated with increased numbers of ICU admissions and rates, and transfer from the ward of less severely ill patients. However, rapid response team implementation did not improve the severity-of-illness-adjusted outcome of patients transferred from the ward. Implementation of rapid response team in an institution with a 24/7 ICU consult service may have unforeseen costs without obvious benefit. Our findings highlight that institutions should evaluate the impact of rapid response team on patient outcome and make modifications specific to their practices.

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Section: Discussionsupporting

confidence: 86%

Section: Differences Between Transfers During the Pre-rrt And Rrt Permentioning

confidence: 99%

mentioning

confidence: 99%

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The Impact of Rapid Response Team on Outcome of Patients Transferred From the Ward to the ICU

Karpman

Keegan

Jensen

et al. 2013

Critical Care Medicine

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“…Both may result in a reduction in cardiac arrest calls but only the former will lead to a reduction in hospital mortality. Furthermore, MET may have other benefits such as preventing deterioration and complications, preventing ICU admissions, ward education and staff satisfaction [30], and 'changing the journey not the outcome' [35], such as when NFR orders are put in place. Therefore, mortality data may only reflect a small part of the total beneficial effects of MET.…”

Section: Discussionmentioning

confidence: 99%

Medical emergency teams are associated with reduced mortality across a major metropolitan health network after two years service: a retrospective study using government administrative data

Tobin

Santamaria

2012

Crit Care

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IntroductionMedical emergency teams (MET) are implemented to ensure prompt clinical review of patients with deteriorating physiology with the intention of averting further deterioration, cardiac arrest and death. We sought to determine if MET implementation has led to reductions in hospital mortality across a large metropolitan health network utilising routine administrative data submitted by hospitals to the Department of Health Victoria.MethodsThe Victorian admissions episodes data set (VAED) contains data on all individual hospital separations in the State of Victoria, Australia. After gaining institutional ethics approval, we extracted data on all acute admissions to metropolitan hospitals for which we had information on the presence and timing of a MET system. Using logistic regression we determined whether there was an effect of MET implementation on mortality controlling for age, gender, Charlson comorbidity diagnostic groupings, emergency admission, same day admission, ICU admission, mechanical ventilation, year, indigenous ethnicity, liaison nurse service and hospital designation.Results5911533 individual admissions and 73,599 associated deaths from July 1999 to June 2010 were included in the analysis. 52.2% were male and median age was 57(42-72 IQR). Mortality rates for MET and non-MET periods were 3.92 (3.88-3.95 95%CI) and 4.56 (4.51-4.61 95%CI) deaths per 1000 patient days with a rate ratio after adjustment for year of 0.88 (0.86-0.89 95%CI) P < 0.001. In a multivariable logistic regression, mortality was associated with a MET team being active in the hospital for more than 2 years. The odds ratio for mortality in hospitals where a MET system had been in place for greater than 4 years duration was 0.90 (0.88-0.92). Mortality during the first 2 years of a MET system being in place was not statistically different from pre-MET periods.ConclusionsUtilising routinely collected administrative data we demonstrated that the presence of a hospital MET system for greater than 2 years was associated with an independent reduction in hospital mortality across a major metropolitan health network. Mortality benefits after the introduction of a MET system take time to become apparent.

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“…The fundamental difference is that the MET is activated before a cardiac arrest [24]. The aim is to bring the clinical experts in critical care to the patient before, rather than after, a multiple organ failure or a cardiac arrest [25]. The MET was born in December 1989, at Liverpool hospital, in Sidney [26], to recognize and manage at-risk patients quickly, in general wards, and prevent suboptimal treatments.…”

Section: Box 1 Rapid Response Systems All Over the World Y Medical Ementioning

confidence: 99%

Rapid Response Systems: how to interpret levels of evidence

Difonzo

2017

CMI

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Clinical management abstractBACKGROUND AND AIM: The Rapid Response System (RRS) has been introduced to prevent cardiac arrest, unplanned admissions to the intensive care unit, and death in hospitalized patients. Despite the constant and widespread presence of this system in worldwide hospitals, it remains debated whether its use improves patient outcomes. The aim of this narrative review is to describe the available evidence supporting the effectiveness of RRSs and to discuss the controversies on the lack of level 1 evidence studies. METHODS: The literature search covers the period from 1 January 2000 to 31 March 2016. RESULTS: Studies with different research designs, observational, quasi-experimental with non-randomized control group and experimental, and aggregate data of meta-analyses indicate a statistically significant reduction of in-hospital cardiac arrests and hospital mortality associated with the deployment of RRSs. CONCLUSIONS: A RRS is a complex intervention in a complex system, such as a hospital. This complexity does not allow considering experimental trials only as the most appropriate methodology to answer at research objectives. Furthermore, the benefits of a RRS depend greatly on its proper use. Accumulating evidence suggests the importance to investigate barriers and facilitators that can affect the integration, within a hospital, of this complex intervention.

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Introduction of medical emergency teams in Australia and New Zealand: a multicentre study

Cited by 22 publications

References 10 publications

The Impact of Rapid Response Team on Outcome of Patients Transferred From the Ward to the ICU

The Impact of Rapid Response Team on Outcome of Patients Transferred From the Ward to the ICU

Medical emergency teams are associated with reduced mortality across a major metropolitan health network after two years service: a retrospective study using government administrative data

Rapid Response Systems: how to interpret levels of evidence

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