title: Performance of the efferent limb of a rapid response system: an observational study of medical emergency team calls.
abstract: OBJECTIVE
  To determine the distribution of outcomes following a medical emergency team (MET) call using a modified version of the multidisciplinary audit and evaluation of outcomes of rapid response (MAELOR) tool, and to evaluate its usefulness in monitoring the performance of the efferent limb of the rapid response system (RRS) at our institution.
  
  
  METHODS
  An observational study of prospectively collected data including all MET calls at our institution during the 36 weeks study period (23 December 2013 - 31 august 2014). Outcomes of MET calls were registered 24 h after the call occurred and categorized according to the MAELOR tool.
  
  
  RESULTS
  Fifty-five of a total of 308 MET calls were excluded due to prior limitations in treatment. Of the remaining cases 66 % had positive outcomes. Thirty two percent of the calls resulted in transfer to the ICU, of these 73 % occurred within 4 h. Patients remained on the ward in 53 % of the cases, and 56 % of these were no longer triggering at follow up. Nine patients had died at follow-up, three without a DNAR order. Three patients were lost to follow-up, two patients were discharged from the hospital and 25 remained alive on the ward with a DNAR as a consequence of the MET call.
  
  
  CONCLUSIONS
  ICU transfer was implemented rapidly in most cases once the decision was made, but a disturbingly large number of patients, who remained on the ward were still triggering at 24 h follow-up. We found the MAELOR-tool useful to evaluate RRS efferent limb performance.
authors.affiliation: Department of Anesthesiology and Intensive Care, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
authors.forename: Emilie M
authors.initials: EM
authors.lastname: Sørensen
authors.affiliation: Department of Anesthesiology and Intensive Care, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark. john.asger.petersen@regionh.dk.
authors.forename: John Asger
authors.initials: JA
authors.lastname: Petersen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D013997:Time Factors