Medical emergency teams at the ottawa Hospital: the first two years

  • Alan D. Baxter
  • Pierre Cardinal
  • Jonathan Hooper
  • Rakesh Patel
Reports Of Original Investigations

Abstract

Purpose: Medical emergency teams (MET) merge earlier-thanconventional treatment of worrisome vital signs with a skilled resuscitation response team, and may possibly reduce cardiac arrests, postoperative complications, and hospital mortality.

Methods: At the two sites of The Ottawa Hospital, MET was introduced in January 2005. We reviewed call diagnoses, interventions, and outcomes from MET activity, and examined outcomes [cardiac arrests, intensive care unit (ICU) admissions, and readmissions] from Health Records and the ICU database. We compared the first fully operational year, 2006, with pre-MET years, 2003–4.

Results: In 5,741 patient encounters, the teams (nurse, respiratory therapist, and intensivist) responded to 1,931 calls over two years, predominantly for high-risk in-patients. As well, there were 3,810 follow-up visits to these patients and to recently discharged ICU patients. In 2006, there were 40.3 calls/team/1,000 hospital admissions, with 71.2% of in-patient ICU admissions preceded by MET calls. Patient illness severity scores decreased from 4.9±2.6 (mean ± SD) before implementing MET to 2.9±2.3 (P<0.0001) after MET interventions. Intervention on the respiratory system was performed on 72% of patients. Admission to the ICU occurred in 27% of MET patients. Compared with the pre-MET period, we observed decreases in: cardiac arrests (from 2.53±0.8 to 1.3±0.4/1,000 admissions,P<0.001); ICU admissions from in-patient nursing units/month (42.3±7.3 to 37.6±5.1,P=0.05); readmissions after ICU discharge/month (13.5±5.1 to 8.8±4.5,P=0.01); and readmissions within 48 hr of ICU discharge/ month (4.4±2.4 to 2.8±1.0 ICU readmissions/month,P=0.01).

Conclusions: Successful implementation of MET reduces patient morbidity and ICU resource utilization.

Équipes médicales d’urgence l’hôpital d’ottawa : les deux premires années

Résumé

Objectif: Les équipes médicales d’urgence (EMU) combinent un traitement plus précoce que la pratique traditionnelle des signes vitaux inquiétants à une équipe d’intervention de réanimation expérimentée, ce qui pourrait possiblement réduire les arrts cardiaques, les complications postopératoires et la mortalité hospitalire.

Méthode: Les EMU ont été introduites dans les deux sites de l’H?pital d’Ottawa en janvier 2005. Nous avons passé en revue les diagnostics d’appel, les interventions et les pronostics associés à l’activité des EMU, et examiné les devenirs (arrts cardiaques, admission à l’unité des soins intensifs [USI] et réadmissions) à partir des dossiers médicaux et de la base de données de l’unité des USI. Nous avons comparé la premire année compltement opérationnelle, 2006, aux années pré-EMU, 2003–2004.

Résultats: Sur 5741 visites, les équipes (infirmire, inhalothérapeute et intensiviste) ont répondu à 1931 appels en 2 ans, principalement pour des patients hospitalisés à haut risque. De mme, il y a eu 3810 visites de suivi pour ces patients et d’autres patients ayant récemment reçu leur congé de l’USI. En 2006, il y a eu 40,3 appels/équipe/1000 admissions à l’hôpital, et 71,2% des admissions aux USI de patients hospitalisés précédées d’appels EMU. Les scores de sévérité de la maladie des patients ont diminué de 4,9±2,6 (moyenne ± ET) avant la mise en place des EMU à 2,9±2,3 (P<0,0001) après les interventions des EMU. Des interventions au niveau du système respiratoire ont été effectuées chez 72% des patients. L’admission à l’USI a eu lieu pour 27% des patients des EMU. Par rapport à la période pré-EMU, nous avons observé les diminutions suivantes : arrts cardiaques (de 2,53±0,8 à 1,3±0,4/1000 admissions, P<0,0001) ; admissions aux USI de soins hospitaliers/mois (42,3±7,3 à 37,6±5,1, P=0,05) ; réadmissions après congé des USI/mois (13,5±5,1 à 8,8±4,5, P=0,01) ; et réadmissions dans les 48 heures suivant le congé des USI/mois (4,4±2,4 à 2,8±1,0 réadmissions aux USI/mois, P=0,01).

Conclusion: La mise en place réussie d’EMU réduit la morbidité des patients et l’utilisation des ressources des USI.

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Copyright information

© Canadian Anesthesiologists 2008

Authors and Affiliations

  • Alan D. Baxter
    • 4
    • 2
  • Pierre Cardinal
    • 1
    • 3
  • Jonathan Hooper
    • 1
    • 2
  • Rakesh Patel
    • 1
    • 3
  1. 1.From the Department of Critical CareThe Ottawa HospitalOttawaCanada
  2. 2.Department of AnesthesiaThe Ottawa HospitalOttawaCanada
  3. 3.Department of MedicineThe Ottawa HospitalOttawaCanada
  4. 4.Department of Anesthesia, The Ottawa HospitalGeneral CampusOttawaCanada

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