title: The role of the medical emergency team in end-of-life care: a multicenter, prospective, observational study.
abstract: OBJECTIVE
  To investigate the role of medical emergency teams in end-of-life care planning.
  
  
  METHODS
  One month prospective audit of medical emergency team calls.
  
  
  METHODS
  Seven university-affiliated hospitals in Australia, Canada, and Sweden.
  
  
  METHODS
  Five hundred eighteen patients who received a medical emergency team call over 1 month.
  
  
  METHODS
  None.
  
  
  RESULTS
  There were 652 medical emergency team calls in 518 patients, with multiple calls in 99 (19.1%) patients. There were 161 (31.1%) patients with limitations of medical therapy during the study period. The limitation of medical therapy was instituted in 105 (20.3%) and 56 (10.8%) patients before and after the medical emergency team call, respectively. In 78 patients who died with a limitation of medical therapy in place, the last medical emergency team review was on the day of death in 29.5% of patients, and within 2 days in another 28.2%.Compared with patients who did not have a limitation of medical therapy, those with a limitation of medical therapy were older (80 vs. 66 yrs; p < .001), less likely to be male (44.1% vs. 55.7%; p = .014), more likely to be medical admissions (70.8% vs. 51.3%; p < .001), and less likely to be admitted from home (74.5% vs. 92.2%, p < .001). In addition, those with a limitation of medical therapy were less likely to be discharged home (22.4% vs. 63.6%; p < .001) and more likely to die in hospital (48.4% vs. 12.3%; p < .001). There was a trend for increased likelihood of calls associated with limitations of medical therapy to occur out of hours (51.0% vs. 43.8%, p = .089).
  
  
  CONCLUSIONS
  Issues around end-of-life care and limitations of medical therapy arose in approximately one-third of calls, suggesting a mismatch between patient needs for end-of-life care and resources at participating hospitals. These calls frequently occur in elderly medical patients and out of hours. Many such patients do not return home, and half die in hospital. There is a need for improved advanced care planning in our hospitals, and to confirm our findings in other organizations.
authors.affiliation: Division of Critical Care Medicine, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada. Daryl.Jones@austin.org.au
authors.forename: Daryl A
authors.initials: DA
authors.lastname: Jones
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.forename: Jonathon
authors.initials: J
authors.lastname: Barrett
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Gaurav
authors.initials: G
authors.lastname: Bhatia
authors.forename: Tracey K
authors.initials: TK
authors.lastname: Bucknall
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Casamento
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Duke
authors.forename: Noel
authors.initials: N
authors.lastname: Gibney
authors.forename: Graeme K
authors.initials: GK
authors.lastname: Hart
authors.forename: Ken M
authors.initials: KM
authors.lastname: Hillman
authors.forename: Gabriella
authors.initials: G
authors.lastname: Jäderling
authors.forename: Ambica
authors.initials: A
authors.lastname: Parmar
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Parr
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002170:Canada; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning / Q000706:statistics & numerical data; D010348:Patient Care Team; D010819:Physician's Role; D011446:Prospective Studies; D013548:Sweden; D013727:Terminal Care / Q000706:statistics & numerical data; D000078329:Workforce