title: Characteristics and outcomes for hospitalized patients with recurrent clinical deterioration and repeat medical emergency team activation*.
abstract: OBJECTIVE
  To describe the occurrence of recurrent clinical deterioration and repeat medical emergency team activation and assess its effect on processes and outcomes of care.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Two community hospitals and two tertiary care hospitals, Alberta, Canada.
  
  
  METHODS
  Consecutive hospitalized adult patients with sudden clinical deterioration and medical emergency team activation without admission to ICU.
  
  
  METHODS
  None.
  
  
  RESULTS
  We compared ICU admission rates (admissions > 2 hr following index medical emergency team), hospital length of stay, and hospital mortality for a cohort of 3,200 patients with and without recurrent clinical deterioration following medical emergency team activation adjusting for patient, provider, and hospital characteristics.The cohort consisted of 3,200 patients. Ten percent of patients (n = 337) experienced recurrent clinical deterioration and repeat medical emergency team activation during their hospital stay. Patients more likely to experience recurrent clinical deterioration and repeat medical emergency team activation included those with chronic liver disease (odds ratio, 1.75; 95% CI, 1.14-2.69) or who received airway suctioning (odds ratio, 1.66; 95% CI, 1.23-2.25), noninvasive mechanical ventilation (odds ratio, 1.67; 95% CI, 0.94-2.94), or central IV catheter insertion (odds ratio, 1.81; 95% CI, 1.02-3.21) during the index medical emergency team activation. Patients with recurrent clinical deterioration were more likely than patients without recurrent clinical deterioration to be subsequently admitted to ICU (43% vs 13%; odds ratio, 6.11; 95% CI, 4.67-8.00; p < 0.01), to have longer lengths of hospital stay (median, 31 d vs 13 d; p < 0.01), and to die during their hospital stay (34% vs 23%; odds ratio, 1.98; 95% CI, 1.47-2.67; p < 0.01).
  
  
  CONCLUSIONS
  Recurrent clinical deterioration and repeat medical emergency team activation are common and associated with increased risk of subsequent ICU admission, increased length of hospital stay, and increased hospital mortality. It may be possible to identify patients at risk of recurrent clinical deterioration following medical emergency team activation and target interventions to improve patient care.
authors.affiliation: 1Departments of Critical Care Medicine, Medicine, and Community Health Sciences, Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB, Canada. 2Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada. 3Alberta Health Services, Edmonton, AB, Canada.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.forename: Song
authors.initials: S
authors.lastname: Gao
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors