The relationship between early emergency team calls and serious adverse events.
OBJECTIVE
To examine the relationship between early emergency team calls and the incidence of serious adverse events--cardiac arrests, deaths, and unplanned admissions to an intensive care unit--in a cluster randomized controlled trial of medical emergency team implementation (the MERIT study).


METHODS
Post hoc analysis of data from cluster randomized controlled trial.


METHODS
Twenty-three public hospitals in Australia and 741,744 patients admitted during the conduct of the study.


METHODS
Attendance by a rapid response system team or cardiac arrest team.


METHODS
The relationship between the proportion of rapid response system team calls that were early emergency team calls (defined as calls not associated with cardiac arrest or death) and the rate (events/1000 admissions) of the adverse events.


RESULTS
We analyzed 11,242 serious adverse events and 3700 emergency team calls. For every 10% of increase in the proportion of early emergency team calls there was a 2.0 reduction per 10,000 admissions in unexpected cardiac arrests (95% confidence interval [CI] -2.6 to -1.4), a 2.2 reduction in overall cardiac arrests (95% CI -2.9 to -1.6), and a 0.94 reduction in unexpected deaths (95% CI -1.4 to -0.5). We found no such relationship for unplanned intensive care unit admissions or for the aggregate of unexpected cardiac arrests, unplanned intensive care unit admissions, and unexpected deaths.


CONCLUSIONS
As the proportion of early emergency team calls increases, the rate of cardiac arrests and unexpected deaths decreases. This inverse relationship provides support for the notion that early review of acutely ill ward patients by an emergency team is desirable.
Chen
Jack
J
Simpson Centre for Health Services Research, University of New South Wales, Sydney, New South Wales, Australia. jackchen@unsw.edu.au
Bellomo
Rinaldo
R
Flabouris
Arthas
A
Hillman
Ken
K
Finfer
Simon
S
D004638:Emergency Treatment / Q000592:standards*; D005260:Female; D006323:Heart Arrest / Q000517:prevention & control*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D013997:Time Factors