A laboratory‐derived early warning score for the prediction of in‐hospital mortality, ICU admission, Medical Emergency Team activation and Cardiac Arrest in general medical wards

2019 ◽  
Author(s):  
Hasanka Ratnayake ◽  
Douglas Johnson ◽  
Johan Martensson ◽  
Que Lam ◽  
Rinaldo Bellomo
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Early Warning ◽  
Medical Emergency Team ◽  
Early Warning Score ◽  
Medical Emergency ◽  
Emergency Team ◽  
Icu Admission ◽  
Medical Wards

Medical emergency team activation: performance of conventional dichotomised criteria versus national early warning score

2014 ◽  
Vol 58 (4) ◽  
pp. 411-419 ◽  
Author(s):  
JOONAS TIRKKONEN ◽  
KLAUS T. OLKKOLA ◽  
HEINI HUHTALA ◽  
JYRKI TENHUNEN ◽  
SANNA HOPPU
Keyword(s):  
Early Warning ◽  
Medical Emergency Team ◽  
Early Warning Score ◽  
Medical Emergency ◽  
Emergency Team ◽  
National Early Warning Score

Outcomes following changing from a two-tiered to a three-tiered hospital rapid response system

2019 ◽  
Vol 43 (2) ◽  
pp. 178
Author(s):  
The Concord Medical Emergency Team Study Investigators
Keyword(s):  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Patient Outcomes ◽  
Medical Emergency Team ◽  
Rapid Response ◽  
Medical Emergency ◽  
Rapid Response System ◽  
Structured Interviews ◽  
Emergency Team ◽  
Response System

Objectives The aim of the present study was to determine whether changing a hospital rapid response system (RRS) from a two-tiered to a three-tiered model can reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. Methods Staff at an Australian teaching hospital attending medical emergency team and cardiac arrest (MET/CA) calls were interviewed after the RRS was changed from a two-tiered to three-tiered model, and the results were compared with a study using the same methods conducted before the change. The main outcome measures were changes in: (1) the incident rate resulting from staff leaving normal duties to attend MET/CA calls; (2) the cardiac arrest rate, (3) unplanned intensive care unit (ICU) admission rates; and (4) hospital mortality. Results We completed 1337 structured interviews (overall response rate 65.2%). The rate of incidents occurring as a result of staff leaving normal duties to attend MET/CA calls fell from 213.7 to 161.3 incidents per 1000 MET/CA call participant attendances (P<0.001), but the rate of cardiac arrest and unplanned ICU admissions did not change significantly. Hospital mortality was confounded by the opening of a new palliative care ward. Conclusion A three-tiered RRS may reduce disruption to normal hospital routines while maintaining the same overall patient outcomes. What is known about the topic? RRS calls result in significant disruption to normal hospital routines because staff can be called away from normal duties to attend. The best staffing model for an RRS is currently unknown. What does this paper add? The present study demonstrates, for the first time, that changing a hospital RRS from a two-tiered to a three-tiered model can reduce the rate of incidents reported by staff caused by leaving normal duties to attend RRS calls while maintaining the same overall patient outcomes. What are the implications for practitioners? Hospitals could potentially reduce disruption to normal hospital routines, without compromising patient care, by changing to a three-tiered RRS.

scholarly journals Automated alert and activation of medical emergency team using early warning score

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Soo Jin Na ◽  
Ryoung-Eun Ko ◽  
Myeong Gyun Ko ◽  
Kyeongman Jeon
Keyword(s):  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Medical Emergency Team ◽  
Early Warning Score ◽  
Medical Emergency ◽  
Alert System ◽  
Primary Analysis ◽  
Emergency Team ◽  
Activation System ◽  
Implementation Period

Abstract Background Timely recognition of warning signs from deteriorating patients and proper treatment are important in improving patient safety. In comparison to the traditional medical emergency team (MET) activation triggered by phone calls, automated activation of MET may minimize activation delays. However, limited data are available on the effects of automated activation systems on the time from derangement to MET activation and on clinical outcomes. The objective of this study was to determine the impact of an automated alert and activation system for MET on clinical outcomes in unselected hospitalized patients. Methods This is an observational study using prospectively collected data from consecutive patients managed by the MET at a university-affiliated, tertiary hospital from March 2013 to December 2019. The automated alert system automatically calculates the Modified Early Warning Score (MEWS) and subsequently activates MET when the MEWS score is 7 or higher, which was implemented since August 2016. The outcome measures of interest including hospital mortality in patients with MEWS of 7 or higher were compared between pre-implementation and post-implementation groups of the automated alert and activation system in the primary analysis. The association between the implementation of the system and hospital mortality was evaluated with logistic regression analysis. Results Of the 7678 patients who were managed by MET during the study period, 639 patients during the pre-implementation period and 957 patients during the post-implementation period were included in the primary analysis. MET calls due to abnormal physiological variables were more common during the pre-implementation period, while MET calls due to medical staff’s worries or concern about the patient’s condition were more common during the post-implementation period. The median time from deterioration to MET activation was significantly shortened in the post-implementation period compared to the pre-implementation period (34 min vs. 60 min, P < 0.001). In addition, unplanned ICU admission rates (41.2% vs. 71.8%, P < 0.001) was reduced during the post-implementation period. Hospital mortality was decreased after implementation of the automated alert system (27.2% vs. 38.5%, P < 0.001). The implementation of the automated alert and activation system was associated with decreased risk of death in the multivariable analysis (adjusted OR 0.73, 95% CI 0.56–0.90). Conclusions After implementing an automated alert and activation system, the time from deterioration to MET activation was shortened and clinical outcomes were improved in hospitalized patients.

scholarly journals A physician-led medical emergency team increases the rate of medical interventions: A multicenter study in Korea

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258221
Author(s):  
Su Yeon Lee ◽  
Jee Hwan Ahn ◽  
Byung Ju Kang ◽  
Kyeongman Jeon ◽  
Sang-Min Lee ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Medical Emergency Team ◽  
Rapid Response ◽  
Medical Emergency ◽  
Arterial Line ◽  
Screening System ◽  
Emergency Team ◽  
Line Insertion ◽  
Icu Transfer ◽  
Portable Ultrasonography

Background According to the rapid response system’s team composition, responding teams were named as rapid response team (RRT), medical emergency team (MET), and critical care outreach. A RRT is often a nurse-led team, whereas a MET is a physician-led team that mainly plays the role of an efferent limb. As few multicenter studies have focused on physician-led METs, we comprehensively analyzed cases for which physician-led METs were activated. Methods We retrospectively analyzed cases for which METs were activated. The study population consisted of subjects over 18 years of age who were admitted in the general ward from January 2016 to December 2017 in 9 tertiary teaching hospitals in Korea. The data on subjects’ characteristics, activation causes, activation methods, performed interventions, in-hospital mortality, and intensive care unit (ICU) transfer after MET activation were collected and analyzed. Results In this study, 12,767 cases were analyzed, excluding those without in-hospital mortality data. The subjects’ median age was 67 years, and 70.4% of them were admitted to the medical department. The most common cause of MET activation was respiratory distress (35.1%), followed by shock (11.8%), and the most common underlying disease was solid cancer (39%). In 7,561 subjects (59.2%), the MET was activated using the screening system. The commonly performed procedures were arterial line insertion (17.9%), intubation (13.3%), and portable ultrasonography (13.0%). Subsequently, 29.4% of the subjects were transferred to the ICU, and 27.2% died during hospitalization. Conclusions This physician-led MET cohort showed relatively high rates of intervention, including arterial line insertion and portable ultrasonography, and low ICU transfer rates. We presume that MET detects deteriorating patients earlier using a screening system and begins ICU-level management at the patient’s bedside without delay, eventually preventing the patient’s condition from worsening and transfer to the ICU.

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