Medical emergency teams at The Ottawa Hospital: the first two years.

摘要

PURPOSE: Medical emergency teams (MET) merge earlier-than-conventional 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 byMET 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.