1. Question Are Medical Emergency Team calls effective in reducing cardiopulmonary arrest rates in the general medical surgical setting? Problem The degree to which adverse events such as cardiopulmonary arrest are preventable is unclear. Concerns about patient safety in acute care hospitals have led to national patient safety initiatives to reduce adverse events and to prevent avoidable deaths among hospitalized patients. One initiative is that early premonitory signs of arrest and to intervene promptly to prevent such outcomes have led to the creation of rapid response teams (RRTs), also called Medical Emergency Teams (METs). Medical Emergency Teams are made up of a multidisciplinary group of personnel that respond to deteriorating patients outside the critical care setting. The purpose of these teams is to identify and treat patients before the patients’ condition deteriorates to the point that cardiopulmonary resuscitation is needed (Scott, 2009). Specialized units such as ICU, ER, and PACU, have sufficient equipment and personnel already on site whereas medical and surgical units typically do not. The use of a Medical Emergency Team is to stabilize patients before they go in to cardiopulmonary arrest. Medical Emergency Teams have been shown to reduce cardiopulmonary arrests outside the Intensive Care Unit. Methods A literature search was performed using the following electronic databases: MEDLINE, Ovid, CINAHL, and Cochrane. Keywords: Medical emergency teams, rapid response teams, cardiac arrests, cardiopulmonary arrests. Eight articles fitting the search criteria were reviewed however only five were included in this review. Two articles were greater than 10 years old and one article was about interviewing the Medical Emergency Team staff. Findings Jolley and colleagues conducted a quasi-experimental design study researching the implementation of a rapid response team at a 488 bed Level I trauma and medical center. Data was collected over a 12 month period and consisted of all patients outside critical care units. The results indicated that 76 RRT calls were activated. They reported a 21% decrease of codes called outside the ICU since implementation of the RRT. Beitler and colleagues conducted a long-term cohort study on the reduction of mortality and cardiopulmonary arrest codes out of the ICU. Over a 3-year time period there were 855 inpatient RRTs activated. They found that out-of-ICU cardiopulmonary arrest codes significantly decreased from 3.28 to 1.62 codes per 1,000 discharges after RRT implementation. There were 132 fewer out-of- ICU codes found after the implementation of the RRT. Chan and colleagues studied the rates of hospital-wide codes and mortality before and after implementation of a long term rapid response team intervention. This was a prospective cohort study of adult patients in a 404-bed hospital admitted during a 19 month period. There were a total of 376 rapid response team activations. A decrease in hospital wide code rates from 11.2 to 7.5 per 1000 admissions was reported. They found that implementation of a rapid response team was not associated with lower hospital-wide code rates. Scott and colleagues conducted a study on the success of implementing a rapid response team. They reported that their number of codes called has decreased since the implementation of the team. In the year before the implementation, a mean of 22 codes were called per month. Two years after the implementation a mean of 14 codes were called per month. The overall code blue rate decreased from 7 per 1000 patient days to 2 per 1000 patient days. Bader and colleagues collected data 12 months before and 12 months after the implementation of a RRT. Data was collected in a 304 bed hospital. This hospital wanted to decrease the number of codes outside the ICU. There was an average of 338 RRT calls activated per month. Outside of the ICU, there was a reduction of cardiac arrests from 36 per year to 17 per year after implementation of a RRT. Synthesis The purpose of this literature review was to examine the evidence surrounding medical emergency teams and their effectiveness in reducing cardiopulmonary arrests in a hospital setting. Six studies were reviewed. Of these studies, five reported an overall effectiveness of medical emergency teams while one reported no significant change. In all of these studies, there was a reduction in overall cardiopulmonary arrest rates after Medical Emergency Teams were implemented. The findings suggest that when Medical Emergency Teams are activated, cardiopulmonary arrests are decreased. Limitations This literature review was restricted by the number of individual studies available. Multiple databases were searched in an attempt to access as many trials available to ensure better comparability. Pediatric research was excluded from this search. The criteria to activate Medical Emergency Teams were somewhat different among facilities. Parameters that define the key characteristics of when to trigger activating a Medical Emergency Teams were not stated in all of the studies. Another limitation is the composition of the team. This was not standardized and varied among hospitals. Some hospitals have limited funds to invest in the personnel that make up the medical emergency team. Implications Further Research Further research should be done to provide the effects on clinical outcomes of Medical Emergency Teams. Further studies are needed to investigate effective implementation of the Medical Emergency Teams process to ensure optimum utilization. More research is needed to establish the composition of the team. References Bader, M., B, N., & L, J. (2009). Rescue me: saving the vulnerable non-ICD patient population. J Comm J Qual Patient Saf, 199-205. Beitler J, L. N. (2011). Reduction in hospital-wide mortality after implementation of a rapidresponse team: a long-term cohort study. Critical Care Forum, 1-10. Chan P, K. A. (2008). Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA, 2506-2513. Jolley J, B. H. (2007). Rapid response teams: do they make a difference? Research Dimension, 253-260. Scott S, E. S. (2009). Implementation of a rapid response team: a success story. Critical Care Nurse, 66-74. Implement a Medical Emergency System Compose a Team: ICU Nurse, Respiratory Therapist, Physician Establish Criteria For Activating a MET Measure Effectiveness Hang up Posters & Distribute Pocket Cards Educate and Train Staff

2. First ArticleDesign/ Method Sample/ Setting InterventionFindings Bader, M. B.N. (2009). Rescue me: saving the vulnerable non-ICU patient population. J Comm J Qual Patient Saf, 199-205. Purpose: To reduce the incidence and mortality of non-ICU arrests utilizing a RRT Prospective design Data collected 12 months before and 12 months after implementation of a RRT Sample: Adult inpatients excluding ICU Setting: 304 bed acute care hospital There were 118 calls per 1,000 discharges; 138 calls per month were in support of the ED. Reduction in non-ICU arrests from 36 per year to 17 per year after implementation of the RRT. Mortality rate decreased from 61% to 26%. Beitler J, L. N. (2011). Reduction in hospital-wide mortality after implementation of a rapidresponse team: a long-term cohort study. Critical Care Forum, 1- 10. Purpose: Primary outcome is to assess if there is a reduction in hospital-wide mortality associated with RRT implementation Cohort design Study conducted over a 6 year time period- 3 years pre-implementation and 3 years post implementation of a RRT Sample: Adult inpatients Setting: 809 bed tertiary public teaching hospital RRT: Consisted of medical consult resident, senior medical house officer, ICU nurse, respiratory therapist, patient transporter Criterion for RRT activation: Pre-specified vital signs criteria Other Clinical concerns Over a 3-year time period there were 855 inpatient RRTs activated. They found that out-of-ICU cardiopulmonary arrest codes significantly decreased from 3.28 to 1.62 codes per 1,000 discharges after RRT implementation. There were 132 fewer out-of- ICU codes found after the implementation of the RRT. Chan P, K. A. (2008). Hospital-wide code rates and mortality before and after implementation of a rapid response team. JAMA, 2506-2513. Purpose: To determine the rates of hospital-wide codes and mortality before and after implementation of a long-term rapid response team intervention Prospective cohort design Study conducted over a 12 month period Sample: Adult inpatients inside and outside the ICU Setting: 404-bed tertiary hospital RRT: Two ICU nurses, respiratory therapist (no other staff reported) Criterion for RRT activation: No specified criteria, just defined them as “Standard criteria” Acute change in mental status Chest Pain Other Clinical concerns There were a total of 376 rapid response team activations. A decrease in hospital wide code rates from 11.2 to 7.5 per 1000 admissions was reported. They found that implementation of a rapid response team was not associated with lower hospital-wide code rates. Jolley J, B. H. (2007). Rapid response teams: Do they make a difference? Research Dimension, 253- 260. Purpose: To assess if RRTs make a difference in the number of codes called outside the critical care units and do they make a difference if mortality rates Quasi-experimental design (No randomization or control group) Data collected over a 12 month period Sample: All inpatient units excluding critical care units Setting: 488 bed Level I trauma and teaching medical center RRT: CCU nurse, respiratory therapist (no other staff reported) Criterion for RRT activation: No specified vital signs criteria, just defined them as “Acute changes” Change in mental status Failure to respond to treatment Seizures Significant bleeding Other Clinical concerns The results indicated that 76 RRT calls were activated. They reported a 21% decrease of codes called outside the ICU since implementation of the RRT. Scott S, E. S. (2009). Implementation of a rapid response team: a success story. Critical Care Nurse, 66-74. Purpose: To assess the success of implementing a rapid response team. Data collected over a 3 year period- 1 year prior to implementation and 2 years after Sample: Adult inpatients Setting: 640 bed teaching medical center RRT: CCU nurse, Infusion nurse, respiratory therapist. Physician not included due to them being present on the units Criterion for RRT activation: Pre-specified vital signs criteria Chest Pain Altered mental status Other Clinical concerns The number of codes called decreased since the implementation of the team. In the year before the implementation, a mean of 22 codes were called per month. Two years after the implementation a mean of 14 codes were called per month. The overall code blue rate decreased from 7 per 1000 patient days to 2 per 1000 patient days. RRT = Rapid Response Team; ICU = Intensive Care Unit; CCU = Critical Care Nurse