Triggers for emergency team activation: A multicenter assessment☆☆☆
published online 02 March 2010.
Abstract
Purpose
The purpose of the study was to examine triggers for emergency team activation in hospitals with or without a medical emergency team (MET) system.
Materials and Methods
Within a cluster randomized controlled trial examining the effect of introducing a MET system, we recorded the triggers for emergency team activation. We compared the proportion and rate of such triggers in hospitals with or without a MET system and in relation to type of hospital, type of patient ward, and time of day.
Results
In control hospitals, the most common trigger for emergency team activation was a decrease in Glasgow Coma Score by 2 or more points (45.6%), whereas in MET hospitals, it was the fact that staff members were “worried” or the call occurred despite the lack of a “specified reason” (39.3%). In particular, MET hospitals were 35 times more likely to make a call because of staff being “worried” about the patient (14.1% vs 0.4%, P < .001). Control hospitals were also significantly more likely to call an emergency team because of a deteriorating respiratory (P = .003) or pulse (P < .001) rate, more calls had at least 3 triggers for activation (20.8% vs 10.2%, P = .036), and the average number of triggers per call was significantly higher (P = .013). Nonmetropolitan hospitals were more likely to call an emergency team because of respiratory rate abnormalities (33.6% vs 23.2%, P = .015). Coronary care unit calls were more likely to be triggered by abnormalities in pulse rate and systolic blood pressure, and more calls occurred during the period from 6:00 am to noon.
Conclusions
In MET hospitals, more emergency team calls are triggered because staff members are worried about the patient; and fewer calls have multiple triggers. Type of hospital, type of ward, and time of day also affect the nature and frequency of triggers for emergency team activation.
aSimpson Centre for Health Services Research, University of New South Wales, Sydney, New South Wales, Australia
bIntensive Care Unit, Austin Medical Centre, Melbourne, Victoria, Australia
cIntensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
dIntensive Care Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
Corresponding author. The Simpson Centre for Health Services Research, Liverpool Health Service, Liverpool BC, Sydney NSW 1871, Australia. Tel.: +61 2 9612 0635; fax: +61 2 9612 0742.
☆ The MERIT study is a collaboration of the Simpson Centre for Health Services Research and the Australian and New Zealand Intensive Care Society Clinical Trials Group.
☆☆ Sources of support for the study: The study was funded by grants from the National Health and Medical Research Council of Australia, the Australian Council for Safety and Quality in Health Care, and the Australian and New Zealand Intensive Care Foundation as part of the MERIT study.
ABSTRACT