Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates*

Bellomo, Rinaldo; Goldsmith, Donna; Uchino, Shigehiko; Buckmaster, Jonathan; Hart, Graeme K; Opdam, Helen; Silvester, William; Doolan, Laurie; Gutteridge, Geoffrey A

doi:10.1097/01.ccm.0000119428.02968.9e

Cited by 452 publications

(297 citation statements)

References 26 publications

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“…Two studies 37,38 focused on pediatric inpatients, and the remainder involved hospitalized adults. The RRS intervened for all hospitalized patients in all but 2 studies (1 of which focused on surgical inpatients 33 and the other in which the RRS Elements affecting study internal validity and translatability. These elements were chosen based on the methods of the Cochrane collaboration.…”

Section: Characteristics Of Included Trialsmentioning

confidence: 99%

“…Seven studies 22,23,31,33,34,36,37 that described the team composition used variants of the medical emergency team model, a physician-led team (Table 2). In 6 of these 7 studies, the team included a critical care physician (attending or fellow) and an ICU nurse; in the sole RCT (the MERIT study 36 ), the team structure varied between hospitals, consisting of a nurse and physician from either the emergency department or ICU.…”

Section: Rrs Structure Calling Criteria and Responsibilitiesmentioning

confidence: 99%

“…Hospitalists, who are involved in RRS responses at many U.S. hospitals, were primary team leaders of the RRS in only 1 study. 31 In 2 studies 34,37 the RRS also responded to code blue calls, and in 4 studies 23,31,33,39 the RRS and the code blue team had separate personnel; the remaining studies did not define the distinction between RRS and code blue team. In 4 studies the RRSs were led by nurses.…”

Section: Rrs Structure Calling Criteria and Responsibilitiesmentioning

confidence: 99%

“…Three studies 3,24,35 used a formal clinical score (the PatientAt-Risk score or the Modified Early Warning score) to trigger calls to the RRS. Three studies, 2 of them from the same institution, 23,33 reported the frequency of specific triggers for RRS activation. Concern by bedside staff and respiratory distress were the most frequent activators of the RRS.…”

Section: Rrs Structure Calling Criteria and Responsibilitiesmentioning

confidence: 99%

“…Nine studies 3,22,23,33,[35][36][37]39,40 reported the effect of an RRS on inpatient mortality, 9 studies 22,23,31,33,34,[36][37][38]40 reported its effect on cardiopulmonary arrests, and 6 studies 3,22,24,33,36,37 reported its effect on unscheduled ICU admissions. Of these, 7 trials that reported mortality and cardiopulmonary arrests and 6 studies that reported unscheduled ICU admissions supplied sufficient data for meta-analysis.…”

Section: Effects Of Rrs On Clinical Outcomesmentioning

confidence: 99%

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

Ranji

Auerbach

Hurd

et al. 2007

Journal of Hospital Medicine

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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.

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Section: Characteristics Of Included Trialsmentioning

confidence: 99%

Section: Rrs Structure Calling Criteria and Responsibilitiesmentioning

confidence: 99%

Section: Rrs Structure Calling Criteria and Responsibilitiesmentioning

confidence: 99%

Section: Rrs Structure Calling Criteria and Responsibilitiesmentioning

confidence: 99%

Section: Effects Of Rrs On Clinical Outcomesmentioning

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

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

Hravnak¹

2008

Arch Intern Med

113

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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.

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Transition From a Traditional Code Team to a Medical Emergency Team and Categorization of Cardiopulmonary Arrests in a Children's Center

Hunt

Zimmer

Rinke

et al. 2008

Arch Pediatr Adolesc Med

110

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To study the effect of an intervention on prevention of respiratory arrest and cardiopulmonary arrest (CPA) and to characterize ward CPAs by preceding signs and symptoms and initial cardiac rhythm.Design: A before-and-after interventional trial (12 months preintervention and 12 months postintervention).Setting: A tertiary care, academic children's hospital.Participants: Admitted patients who subsequently had either the code team or pediatric medical emergency team (PMET) called or who had a respiratory arrest or CPA on the wards.Intervention: Transition from a traditional code team to a PMET that responds to clinically deteriorating children in noncritical care areas.Outcome Measures: Combined rate of respiratory arrests and CPAs, rate of CPAs, and rate of respiratory ar-rests on the wards and agreement between independent reviewers on categorization of CPAs.

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Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates*

Abstract: The introduction of an intensive care unit-based medical emergency team in a teaching hospital was associated with a reduced incidence of postoperative adverse outcomes, postoperative mortality rate, and mean duration of hospital stay.

Cited by 452 publications

References 26 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

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

Transition From a Traditional Code Team to a Medical Emergency Team and Categorization of Cardiopulmonary Arrests in a Children's Center

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