The Medical Emergency Team in Italy: an overview of in-hospital emergencies response An overview of in-hospital emergencies response

Main Article Content

Alessandro Galazzi https://orcid.org/0000-0003-0085-7015
Nicola Maria Bonasera Vincenti
Gian Domenico Giusti
Matteo Brioni
Ileana Adamini
Dario Laquintana
Giuseppe Ristagno
Giacomo Grasselli

Keywords

In-hospital emergency, Rapid Response System, Medical Emergency Team, Nurse, Survey

Abstract

Background and aim: Medical Emergency Team (MET), implemented in many hospitals worldwide, aims to improve the safety of in-hospital patients whose condition is deteriorating. This study describes MET presence and organization in the Italian National Healthcare System Hospitals. Methods: A national survey with an online questionnaire was performed. The questionnaire, created ad hoc, was sent by e-mail to the nursing coordinators and MET referents of the Hospitals affiliated to the Italian National Healthcare System with an Anesthesia and Intensive Care service. Results: One hundred-ninety-seven hospitals were interviewed (36.2% of the whole national network). A dedicated MET, composed at least by an intensivist and a nurse, was present only in 118 cases (59.9%). The team was composed by a non-dedicated staff (67.8% of doctors, 69.5% of nurses) and a minimum shared standard of education for the nurse component was absent. One third of the estimated hospitals did not use a warning score for emergency call activation. Discussion and conclusion: This survey showed a heterogenous and often lacking organization of in-hospital emergency management in Italy. MET system needs to be implemented in terms of presence in the Italian hospitals, and standardized for personnel structure and training, and equipment availability. A broader study is necessary to compare our data with those of other European Countries to better identify the specific areas which need to be improved more promptly.

Downloads

Download data is not yet available.
Abstract 426 | PDF Downloads 113

References

1. Subbe CP, Bannard-Smith J, Bunch J, Champunot R, DeVita MA, Durham L, Edelson DP, Gonzalez I, Hancock C, Haniffa R, et al. International Society for Rapid Response Systems. Quality metrics for the evaluation of Rapid Response Systems: Proceedings from the third international consensus conference on Rapid Response Systems. Resuscitation 2019;141:1-12.
2. Jones CM, Bleyer AJ, Petree B. Evolution of a rapid response system from voluntary to mandatory activation. Jt Comm J Qual Patient Saf 2010;36(6):266- 70.
3. Odell M. Detection and management of the deteriorating ward patient: An evaluation of nursing practice. J Clin Nurs 2015;24(1-2):173-82.
4. Brown H, Terrence J, Vasquez P, Bates DW, Zimlichman E. Continuous monitoring in an inpatient medical - surgical unit: A controlled clinical trial. Am J Med 2014;127(3):226-32.
5. Rosen MJ, Hoberman AJ, Ruiz RE, Sumer Z, Jalon HS. Reducing cardiopulmonary arrest rates in a three - year regional rapid response system collaborative. Jt Comm J Qual Patient Saf 2013;39(7):328-36.
6. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM 2001;94(10):521-6.
7. Buist MD. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. Br Med J 2002;324(7334):387-90.
8. DeVita MA, Bellomo R, Hillman K, Kellum J, Rotondi A, Teres D, et al. Findings of the First Consensus Conference on Medical Emergency Teams. Crit Care Med 2006;34(9):2463-78.
9. Rubulotta F, Pinsky MR. Second International Conference on Rapid Response System and Medical Emergency Team, 28 - 30 June 2006, Pittsburgh, PA, USA. Crit Care 2006;10(5):319.
10. Jones D, Lippert A, DeVita M, Hillman K. What’s new with rapid response systems? Intensive Care Med 2014;41(2):315-7.
11. Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med 2011;365(2):139-46.
12. Lyons PG, Edelson DP, Churpek MM. Rapid response systems. Resuscitation 2018;128:191-197.
13. Smith GB. In - hospital cardiac arrest: Is it time for an in - hospital “chain of prevention”? Resuscitation 2010;81(9):1209-11.
14. Chan PS, Jain R, Nallmothu BK, Berg RA, Sasson C. Rapid response teams: A systematic review and meta - analysis. Arch Intern Med 2010;170(1):18-26.
15. Al – Qahtani S, Al – Dorzi HM, Tamim HM, Hussain S, Fong L, Taher S, et al. Impact of an intensivist - led multidisciplinary extended rapid response team on hospital - wide cardiopulmonary arrests and mortality. Crit Care Med 2013;41(2):506-17.
16. Winters BD, Weaver SJ, Pfoh ER, Yang T, Cuong J, Dy SM. Rapid - response systems as a patient safety strategy: A systematic review. Ann Intern Med 2013;158(5 PART 2):417-25.
17. Maharaj R, Raffaele I, Wendon J. Rapid response systems: A systematic review and meta - analysis. Crit Care 2015;19(1):254.
18. Solomon RS, Corwin GS, Barclay DC, Quddusi SF, Dannenberg MD. Effectiveness of rapid response teams on rates of in - hospital cardiopulmonary arrest and mortality: A systematic review and meta - analysis. J Hosp Med 2016;11(6):438-45.
19. Tirkkonen J, Tamminen T, Skrifvars MB. Outcome of adult patients attended by rapid response teams: A systematic review of the literature. Resuscitation 2017; 112:43-52.
20. Sandroni C, D’Arrigo S, Antonelli M. Rapid response systems: Are they really effective? Crit Care 2015;19(1):104.
21. NICE Short Clinical Guidelines Technical Team. Acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital 2007;(50).
22. Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, et al. European Resuscitation Council Guidelines for Resuscitation 2015. Section 3. Adult advanced life support. Resuscitation 2015;95:100-47.
23. Savoia G, Bosco G, Cerchiari E, De Blasio E, Della Corte F, Gordini G, et al. SIAARTI - IRC recommendations for organizing responses to In - Hospital emergencies. Minerva Anestesiol 2007;73(10):533-53.
24. Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva. Available online: http://www.giviti.marionegri.it (accessed on 1 June 2018).
25. INTENSIVA.it. Available online: http://www.intensiva.it (accessed on 1 June 2018).
26. Neumar RW, Shuster M, Callaway CW, Gent LM, Atkins DL, Bhanji F, Brooks SC, de Caen AR, Donnino MW, Ferrer JM, et al. Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132(18 Suppl 2):S315-67.
27. Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J. ERC Guidelines 2015 Writing Group. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015;95:1-80.
28. Lucchini A, De Felippis C, Elli S, Schifano L, Rolla F, Pegoraro F, Fumagalli R. Nursing Activities Score (NAS): 5 years of experience in the intensive care units of an Italian University hospital. Intensive Crit Care Nurs 2014;30(3):152-8.
29. Whitaker DK. Establishing a standard “Cardiac Arrest Call” telephone number for all hospitals in Europe-2222. Resuscitation 2016;105:e25.
30. Giusti GD, Reitano B, Lusignani M, Rasero L, Galazzi A. Italian in-hospital emergency number: A call for action. Resuscitation 2019;140:84-85.
31. Barwise A, Thongprayoon C, Gajic O, Jensen J, Herasevich V, Pickering BW. Delayed Rapid Response Team Activation Is Associated With Increased Hospital Mortality, Morbidity, and Length of Stay in a Tertiary Care Institution. Crit Care Med 2016;44(1):54-63.
32. Downey CL, Tahir W, Randell R, Brown JM, Jayne DG. Strengths and limitations of early warning scores: A systematic review and narrative synthesis. Int J Nurs Stud 2017;76:106-119.
33. Le Lagadec MD, Dwyer T. Scoping review: The use of early warning systems for the identification of in-hospital patients at risk of deterioration. Aust Crit Care 2017;30(4):211-218.
34. Royal College of Physicians. National Early Warning Score (NEWS): Standardising the assessment of acute illness severity in the NHS. Report of a working party. London: RCP, 2012.
35. DeVita MA, Smith GB, Adam SK, Adams-Pizarro I, Buist M, Bellomo R, et al. “Identifying the hospitalised patient in crisis” - A consensus conference on the afferent limb of Rapid Response Systems. Resuscitation 2010;81(4):375-82.

Most read articles by the same author(s)