SESSION TYPE: ICU: Improving Outcomes
PRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AM
PURPOSE: Medical emergency teams (METs) are now widely adopted by hospitals as a means to effectively intervene in the care of patients with unexpected clinical deterioration. There is little reported information regarding the burden of medical illness, patient outcomes, and hospital resource utilization in patients who require medical emergency team intervention.
METHODS: All MET calls and call characteristics at a tertiary academic medical center from September 2009 through 2011 were collected. Baseline characteristics, comorbid conditions included in the Charlson comordity index, were extracted via chart review. Primary outcome was hospital mortality. Secondary outcomes included requirement for ICU admission. Descriptive statistics, Pearson’s chi-square test, bivariate/multivariate logistic regression were utilized for data analysis.
RESULTS: Over the study period, there were 1359 MET calls. The most common co-morbid diseases were diabetes.(n=402,30 %), chronic pulmonary disease (n=271,20 %), CHF (n=217,16 %), cerebrovascular disease (n=203, 15%), and renal failure (n=198,15%)). The median weighted Charlson co-morbidity index was 2(IQR 1-5). Overall hospital mortality was 19.6%. Of the 1359 METs, 38%(n=325) resulted in ICU transfer; the majority of patients (n=793,58.6% ) required ICU admission during their hospital stay, with 22%(n=300) requiring multiple ICU admissions. On multivariate analysis, the following comorbid diseases were independently associated with higher hospital mortality: moderate/severe liver disease (OR 4.99,CI 2.87-8.66), leukemia/lymphoma (OR 3.26,CI 2.14-4.97), metastatic cancer (OR 2.55, CI 1.69-3.83), mild liver disease (OR 1.91, CI 1.14-3.21), and connective tissue disease (OR 1.73, CI 1.09-2.73). ICU transfer at the time of MET was more likely in patients with moderate/severe liver disease (OR 2.17, CI 1.26-3.74) and chronic pulmonary disease (OR 1.32, CI 1.00-1.74). The two co-morbidities associated with more than one ICU admissions were renal disease (OR 1.84 CI 1.26-2.67) and solid tumors (OR 1.82 CI 1.21-2.73).
CONCLUSIONS: Patients who require medical emergency team intervention have a high burden of co-morbid illness and commonly require ICU intervention.
CLINICAL IMPLICATIONS: Identification of high risk co-morbid conditions may assist in development of better triage protocols, as well as more informed patient/family counseling during and after METs.
DISCLOSURE: The following authors have nothing to disclose: Christopher Hanzaker, Jennifer Maguire, Celeste Mayer, Renae Stafford, Lydia Chang
No Product/Research Disclosure InformationUniversity of North Carolina at Chapel Hill, Chapel Hill, NC