title: Intensive care without walls - introduction of a Medical Emergency Team system in a Swiss tertiary care centre.
abstract: OBJECTIVE
  To improve the response of deteriorating patients during their hospital stay, the University Hospital Bern has introduced a Medical Emergency Team (MET). Aim of this retrospective cohort study is to review the preceding factors, patient characteristics, process parameters and their correlation to patient outcomes of MET calls since the introduction of the team.
  
  
  METHODS
  Data on patient characteristics, parameters related to MET activation and intervention and patient outcomes were evaluated. A Vital Sign Score (VSS), which is defined as the sum of the occurrence of each vital sign abnormalities, was calculated for all physiological parameters pre MET event, during event and correlation with hospital outcomes.
  
  
  RESULTS
  A total of 1,628 MET calls in 1,317 patients occurred; 262 (19.9%) of patients with MET calls during their hospital stay died. The VSS pre MET event (odds ratio [OR] 1.78, 95% confidence interval [CI] 1.50-2.13; AUROC 0.63; all p <0.0001) and during the MET call (OR 1.60, 95% CI 1.41-1.83; AUROC 0.62; all p <0.0001) were significantly correlated to patient outcomes. A significant increase in MET calls from 5.2 to 16.5 per 1000 hospital admissions (p <0.0001) and a decrease in cardiac arrest calls in the MET perimeter from 1.6 in 2008 to 0.8 per 1000 admissions was observed during the study period (p = 0.014).
  
  
  CONCLUSIONS
  The VSS is a significant predictor of mortality in patients assessed by the MET. Increasing MET utilisation coincided with a decrease in cardiac arrest calls in the MET perimeter.
authors.affiliation: Department of Intensive Care Medicine, University Hospital (Inselspital) and University of Bern, Bern, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Etter
authors.affiliation: Department of Intensive Care Medicine, University Hospital (Inselspital) and University of Bern, Bern, Switzerland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Takala
authors.affiliation: Department of Intensive Care Medicine, University Hospital (Inselspital) and University of Bern, Bern, Switzerland.
authors.forename: Tobias Michael
authors.initials: TM
authors.lastname: Merz
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D013997:Time Factors