To evaluate the efficacy of a medical emergency team activated using 24-hour monitoring by electronic medical record–based screening criteria followed by immediate intervention by a skilled team.
Retrospective cohort study.
Academic tertiary care hospital with approximately 2,700 beds.
A total of 3,030 events activated by a medical emergency team from March 1, 2008, to February 28, 2010.
Measurements and Main Results:
We collected data for all medical emergency team activations: patient characteristics, trigger type for medical emergency team (electronic medical record–based screening vs calling criteria), interventions during each event, outcomes of the medical emergency team intervention, and 28-day mortality after medical emergency team activation. We analyzed data for 2009, when the medical emergency team functioned 24 hours a day, 7 days a week (period 2), compared with that for 2008, when the medical emergency team functioned 12 hours a day, 7 days a week (period 1). The commonest cause of medical emergency team activation was respiratory distress (43.6%), and the medical emergency team performed early goal-directed therapy (21.3%), respiratory care (19.9%), and difficult airway management (12.3%). For patients on general wards, 51.3% (period 1) and 38.4% (period 2) of medical emergency team activations were triggered by the electronic medical record–based screening system (electronic medical record–triggered group). In 23.4%, activation occurred because of an abnormality in laboratory screening criteria. The commonest activation criterion from electronic medical record–based screening was respiratory rate (39.4%). Over half the patients were treated in the general ward, and one third of the patients were transferred to the ICU. The electronic medical record–triggered group had lower ICU admission with an odds ratio of 0.35 (95% CI, 0.22–0.55). In surgical patients, the electronic medical record–triggered group showed the lower 28-day mortality (10.5%) compared with the call-triggered group (26.7%) or the double-triggered group (33.3%) (odds ratio 0.365 with 95% CI, 0.154–0.867, p = 0.022).
We successful managed the medical emergency team with electronic medical record–based screening criteria and a skilled intervention team. The electronic medical record–triggered group had lower ICU admission than the call-triggered group or the double-triggered group. In surgical patients, the electronic medical record–triggered group showed better outcome than other groups.