Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study.
OBJECTIVE
To determine whether earlier clinical intervention by a medical emergency team prompted by clinical instability in a patient could reduce the incidence of and mortality from unexpected cardiac arrest in hospital.


METHODS
A non-randomised, population based study before (1996) and after (1999) introduction of the medical emergency team.


METHODS
300 bed tertiary referral teaching hospital.


METHODS
All patients admitted to the hospital in 1996 (n=19 317) and 1999 (n=22 847).


METHODS
Medical emergency team (two doctors and one senior intensive care nurse) attended clinically unstable patients immediately with resuscitation drugs, fluid, and equipment. Response activated by the bedside nurse or doctor according to predefined criteria.


METHODS
Incidence and outcome of unexpected cardiac arrest.


RESULTS
The incidence of unexpected cardiac arrest was 3.77 per 1000 hospital admissions (73 cases) in 1996 (before intervention) and 2.05 per 1000 admissions (47 cases) in 1999 (after intervention), with mortality being 77% (56 patients) and 55% (26 patients), respectively. After adjustment for case mix the intervention was associated with a 50% reduction in the incidence of unexpected cardiac arrest (odds ratio 0.50, 95% confidence interval 0.35 to 0.73).


CONCLUSIONS
In clinically unstable inpatients early intervention by a medical emergency team significantly reduces the incidence of and mortality from unexpected cardiac arrest in hospital.
Buist
Michael D
MD
Department of Intensive Care, Dandenong Hospital, Dandenong, VIC 3175, Australia. acmdbuist@bigpond.com
Moore
Gaye E
GE
Bernard
Stephen A
SA
Waxman
Bruce P
BP
Anderson
Jeremy N
JN
Nguyen
Tuan V
TV
D000328:Adult; D000368:Aged; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000517:prevention & control*; D006745:Hospital Bed Capacity, 300 to 499; D017052:Hospital Mortality / Q000639:trends*; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010348:Patient Care Team / Q000458:organization & administration*; D012307:Risk Factors; D014739:Victoria / Q000453:epidemiology