Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team.
OBJECTIVE
To evaluate the effectiveness of a medical emergency team (MET) in reducing the rates of selected adverse events.


METHODS
Cohort comparison study after casemix adjustment.


METHODS
All adult (> or = 14 years) patients admitted to three Australian public hospitals from 8 July to 31 December 1996. INTERVENTION STUDIED: At Hospital 1, a medical emergency team (MET) could be called for abnormal physiological parameters or staff concern. Hospitals 2 and 3 had conventional cardiac arrest teams.


METHODS
Casemix-adjusted rates of cardiac arrest, unanticipated admission to intensive care unit (ICU), death, and the subgroup of deaths where there was no pre-existing "do not resuscitate" (DNR) order documented.


RESULTS
There were 1510 adverse events identified among 50 942 admissions. The rate of unanticipated ICU admissions was less at the intervention hospital in total (casemix-adjusted odds ratios: Hospital 1, 1.00; Hospital 2, 1.59 [95% CI, 1.24-2.04]; Hospital 3, 1.73 [95% CI, 1.37-2.16]). There was no significant difference in the rates of cardiac arrest or total deaths between the three hospitals. However, one of the hospitals with a conventional cardiac arrest team had a higher death rate among patients without a DNR order.


CONCLUSIONS
The MET hospital had fewer unanticipated ICU/HDU admissions, with no increase in in-hospital arrest rate or total death rate. The non-DNR deaths were lower compared with one of the other hospitals; however, we did not adjust for DNR practices. We suggest that the MET concept is worthy of further study.
Bristow
P J
PJ
Liverpool Hospital, Sydney, NSW. p.bristow@alfred.org.au
Hillman
K M
KM
Chey
T
T
Daffurn
K
K
Jacques
T C
TC
Norman
S L
SL
Bishop
G F
GF
Simmons
E G
EG
D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010360:Patient Transfer / Q000706:statistics & numerical data; D015995:Prevalence; D020379:Risk Adjustment