title: Factors associated with delayed activation of medical emergency team and excess mortality: an Utstein-style analysis.
abstract: OBJECTIVE
  We used the Utstein template, with special reference to patients having automated patient monitoring, and studied the factors which are associated with delayed medical emergency team (MET) activation and increased hospital mortality.
  
  
  METHODS
  A prospective observational study in a tertiary hospital with 45 of 769 general ward beds (5.9%) equipped with automated monitoring.
  
  
  METHODS
  569 MET reviews for 458 patients.
  
  
  RESULTS
  Basic MET review characteristics were comparable to literature. We found that 41% of the reviews concerned monitored ward patients. These patients' vitals had been more frequently documented during the 6h period preceding MET activation compared to patients in normal ward areas (96% vs. 74%, p<0.001), but even when adjusted to the documentation frequency of vitals, afferent limb failure (ALF) occurred more often among monitored ward patients (81% vs. 53%, p<0.001). In MET population, factors associated with increased hospital mortality were non-elective hospital admission (OR 6.25, 95% CI 2.77-14.11), not-for-resuscitation order (3.34, 1.78-6.35), ICD XIV genitourinary diseases (2.42, 1.16-5.06), ICD II neoplasms (2.80, 1.59-4.91), age (1.02, 1.00-1.04), preceding length of hospital stay (1.04, 1.01-1.07), ALF (1.67, 1.02-2.72) and transfer to intensive care (1.85, 1.05-3.27).
  
  
  CONCLUSIONS
  Documentation of vital signs before MET activation is suboptimal. Documentation frequency seems to increase if automated monitors are implemented, but our results suggest that benefits of intense monitoring are lost without appropriate and timely interventions, as afferent limb failure, delay to call MET when predefined criteria are fulfilled, was independently associated to increased hospital mortality.
authors.affiliation: Critical Care Medicine Research Group, Department of Intensive Care Medicine, Tampere University Hospital and Medical School, University of Tampere, P.O. Box 2000, FI-33521 Tampere, Finland. joonas.tirkkonen@uta.fi
authors.forename: Joonas
authors.initials: J
authors.lastname: Tirkkonen
authors.forename: Jari
authors.initials: J
authors.lastname: Ylä-Mattila
authors.forename: Klaus T
authors.initials: KT
authors.lastname: Olkkola
authors.forename: Heini
authors.initials: H
authors.lastname: Huhtala
authors.forename: Jyrki
authors.initials: J
authors.lastname: Tenhunen
authors.forename: Sanna
authors.initials: S
authors.lastname: Hoppu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors