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Four years' experience with a hospitalist-led medical emergency team: An interrupted time series

Authors

  • Michael B. Rothberg MD, MPH,

    Corresponding author
    1. Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
    2. Division of General Medicine, Baystate Medical Center, Springfield, Massachusetts
    3. Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
    • Division of General Medicine and Geriatrics, Baystate Medical Center, 759 Chestnut St, Springfield, MA 01199
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    • Telephone: 413-794-3245; Fax: 413-794-9070

  • Raquel Belforti DO,

    1. Division of General Medicine, Baystate Medical Center, Springfield, Massachusetts
    2. Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
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  • Janice Fitzgerald RN, MS, CPHQ,

    1. Division of Healthcare Quality, Baystate Medical Center, Springfield, Massachusetts
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  • Jennifer Friderici MS,

    1. Division of Epidemiology and Biostatistics, Baystate Medical Center, Springfield, Massachusetts
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  • Marjorie Keyes RN, MS

    1. Division of Healthcare Quality, Baystate Medical Center, Springfield, Massachusetts
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  • Disclosure: Nothing to report.

Abstract

BACKGROUND:

The effect of Medical Emergency Teams (METs) on cardiopulmonary arrests (codes) and fatal codes remains unclear and widely debated.

OBJECTIVE:

To describe the implementation of a hospitalist-led MET and compare the number of code calls and code deaths before and after implementation.

DESIGN:

Interrupted time series.

SETTING:

Tertiary care academic medical center.

PATIENTS:

All hospitalized patients.

INTERVENTION:

Implementation of an MET, consisting of a critical care nurse, respiratory therapist, intravenous therapist, and the patient's physician.

MEASUREMENTS:

Number of MET calls, code calls, cardiac arrests and other medical crises, and code deaths per 1000 admissions, stratified by location (inside vs outside critical care).

RESULTS:

From implementation in March 2006 through December 2009, the MET logged 2717 calls, most commonly for respiratory distress (33%), cardiovascular instability (25%), and neurological abnormality (20%). Overall code calls declined significantly between pre-implementation and post-implementation of the MET from 7.30 (95% confidence interval [CI] 5.81, 9.16) to 4.21 (95% CI 3.42, 5.18) code calls per 1000 admissions. Outside of critical care, code calls declined from 4.70 (95% CI 3.92, 5.63) before the MET was implemented to 3.11 (95% CI 2.44, 3.97) afterwards, primarily due to a decrease in medical crises, which averaged 3.29 events per 1000 admissions (95% CI 2.70, 4.02) before implementation and decreased to 1.72 (95% CI 1.28, 2.31) afterwards. Code calls within critical care also declined. The rate of fatal codes was not affected.

CONCLUSIONS:

A hospitalist-led MET decreased code call rates but did not affect mortality rates. Journal of Hospital Medicine 2012;. © 2011 Society of Hospital Medicine

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