title: Triggers for emergency team activation: a multicenter assessment.
abstract: OBJECTIVE
  The purpose of the study was to examine triggers for emergency team activation in hospitals with or without a medical emergency team (MET) system.
  
  
  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.
authors.affiliation: Simpson Centre for Health Services Research, University of New South Wales, Sydney, New South Wales, Australia. jackchen@unsw.edu.au
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Ken
authors.initials: K
authors.lastname: Hillman
authors.forename: Arthas
authors.initials: A
authors.lastname: Flabouris
authors.forename: Simon
authors.initials: S
authors.lastname: Finfer
mesh_terms: D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D015600:Glasgow Coma Scale; D006339:Heart Rate; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006761:Hospitals / Q000145:classification; D006801:Humans; D056152:Respiratory Rate; D000078329:Workforce