Association between implementation of an intensivist-led medical emergency team and mortality

作者：Karvellas Constantine J; de Souza Ivens A O; Gibney R T Noel; Bagshaw Sean M^*

来源：BMJ Quality & Safety, 2012, 21(2): 152-159.

DOI：10.1136/bmjqs-2011-000393

Purpose: To evaluate the impact of implementation of a dedicated intensivist-led medical emergency team (IL-MET) on mortality in patients admitted to the intensive care unit (ICU).
Methods: All adult ward admissions to the ICU between July 2002 and December 2009 were reviewed (n=1920) after excluding readmissions and admissions for <24 h. IL-MET hours were defined as 8:00-15:59 (Monday to Friday). The following periods were analysed: period 1: 1 July 2002-31 August 2004 (control); period 2: 1 September 2004-11 February 2007 (partial MET without dedicated intensivist); and period 3: 12 February 2007-31 December 2009 (hospital-wide IL-MET).
Results: During all three periods, there were no significant differences in length of stay or mortality (IL-MET vs non-IL-MET hours, p>0.1 for all). On multivariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score and age were independently associated with mortality in all three periods (p<0.05 for all). During period 3, there was a non-significant trend towards decreased mortality if admitted during IL-MET hours (OR 0.73, 95% CI 0.51 to 1.03, p=0.08). During period 3, there was a nonsignificant trend towards decreased mortality if admitted during IL-MET hours (OR 0.73, 95% CI 0.51 to 1.03, p 0.08). However, this result likely reflects the observed increase in mortality during non-IL MET hours rather than improved mortality during IL-MET hours.
Conclusion: In a single centre experience, implementation of an IL-MET did not reduce the rate of in-hospital death or lengths of stay.

• 出版日期2012-2