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Title: Physiological antecedents and ward clinician responses before medical emergency team activation.
Austin Authors: Sprogis, Stephanie K;Currey, Judy;Considine, Julie;Baldwin, Ian C ;Jones, Daryl A 
Affiliation: Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
Issue Date: Mar-2017
Publication information: Critical Care and Resuscitation 2017; 19(1): 50-56
Abstract: To investigate the frequency, characteristics and timing of objectively measured clinical instability in adult ward patients in the 24 hours preceding activation of the medical emergency team (MET). We also examined ward clinician responses to documented clinical instability. A descriptive, exploratory design with a retrospective medical record audit. We descriptively analysed data from 200 ward patients reviewed by the MET at a tertiary teaching hospital in Melbourne, Australia, during 2014. Frequency and characteristics of urgent clinical review (UCR) criteria breaches in the 24 hours preceding MET activation, and in-hospital mortality. Overall, 78.5% of patients breached UCR criteria at least once in the 24 hours preceding MET activation, with 80.9% having multiple breaches. The most common causes of UCR criteria breaches were hypoxaemia without supplemental oxygen (27.4%, n = 43) and hypoxaemia with supplemental oxygen (21.7%, n = 34) for first UCR criteria breaches, and tachycardia (33.1%, n = 42) for last UCR criteria breaches during the 24 hours we examined. The median time before MET activation for first and last breaches was 17.1 hours and 1.2 hours, respectively. Examination of the clinician documentation suggested a high incidence of pre-MET activation afferent limb failure. In-hospital mortality was 12%. Patients commonly and repeatedly breached objectively measured UCR criteria in the 24 hours preceding MET activation, providing numerous opportunities for clinicians to recognise and respond to early clinical deterioration. The high incidence of pre- MET afferent limb failure requires further exploration.
PubMed URL: 28215132
ISSN: 1441-2772
Type: Journal Article
Appears in Collections:Journal articles

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