Four years' experience with a hospitalist-led medical emergency team: An interrupted time series

摘要

Background: The effect of Medical Emergency Teams (METs) on cardiopulmonary arrests (codes) and fatal codes remains unclear and widely debated. Objective: To describe the implementation of a hospitalist-led MET and compare the number of code calls and code deaths before and after implementation. Design: Interrupted time series. Setting: Tertiary care academic medical center. Patients: All hospitalized patients. Intervention: Implementation of an MET, consisting of a critical care nurse, respiratory therapist, intravenous therapist, and the patient's physician. Measurements: Number of MET calls, code calls, cardiac arrests and other medical crises, and code deaths per 1000 admissions, stratified by location (inside vs outside critical care). Results: From implementation in March 2006 through December 2009, the MET logged 2717 calls, most commonly for respiratory distress (33%), cardiovascular instability (25%), and neurological abnormality (20%). Overall code calls declined significantly between pre-implementation and post-implementation of the MET from 7.30 (95% confidence interval [CI] 5.81, 9.16) to 4.21 (95% CI 3.42, 5.18) code calls per 1000 admissions. Outside of critical care, code calls declined from 4.70 (95% CI 3.92, 5.63) before the MET was implemented to 3.11 (95% CI 2.44, 3.97) afterwards, primarily due to a decrease in medical crises, which averaged 3.29 events per 1000 admissions (95% CI 2.70, 4.02) before implementation and decreased to 1.72 (95% CI 1.28, 2.31) afterwards. Code calls within critical care also declined. The rate of fatal codes was not affected. Conclusions: A hospitalist-led MET decreased code call rates but did not affect mortality rates.