Impact of a Communication and Team-working Intervention on Performance and Effectiveness of a Medical Emergency Team

Study Overview
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Brief Summary
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Patients in hospital can have unexpected clinical emergencies. When this occurs the Medical Emergency Team (MET) are called with the intention of resolving the problem. Previous investigations have found that patients who have more than one call during their admission have worse outcomes than patients who only have one call. But it has not been established why. The aim of this research will be to examine these repeated calls and why patients subject to them go on to have worse outcomes. A predictive model will be developed to identify potential sources of risk. One potential source is poor communication between health care providers. An intervention to improve communication around MET calls may provide benefit to patients and improve outcomes.

Detailed Description
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This investigation will comprise a mixed methods, before-and-after study. The particulars are: Format: Before intervention Analysis of retrospective MET activity and patient outcome data Surveying of staff for attitudes and perceptions of MET calls Intervention Twice-daily MET briefing meetings Formalised handover process for MET calls resulting in patients remaining in their current clinical area After intervention Analysis of prospective MET activity and patient outcome data Surveying of staff for attitudes and perceptions of MET calls Setting: Lyell McEwin Hospital, a 300 bed, university-affiliated, tertiary, metropolitan hospital located in Adelaide, South Australia. It has comprehensive in-patient medical and surgical services including a Level 3 Intensive Care Unit. Subjects: Patients - adult in-patients attended by the MET during the study period. This will include patients attended more than once during an admission, as all calls will be a separate datapoint. It is also possible for patients to have more than one admission during the study period, so each admission will be considered discretely. Staff - members of the hospital MET and ward staff that may call the MET. The MET composition is an ICU doctor, ICU nurse, medical registrar, intern and hospital manager. Due to rostering demands, this team is supplied from a pool of staff within each of the representative departments (approximately 10 ICU doctors, 30 ICU nurses, 30 medicine registrars, 36 interns and 8 duty managers). Data Collection: Characteristics and Outcomes Per-hospital admission data includes: age, gender, admission diagnosis, admission type, length of stay and mortality Per-MET call data includes: reason for call, location, duration of call, interventions performed, disposition and mortality Perceptions and Attitudes Ward staff question including around interactions with MET, involvement during MET calls, experience of repeat calling and reasons for repeat calling MET questions including around interactions with ward staff, involvement of ward staff during calls and resolution of calls.

Official Title
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Impact of a Communication and Team-working Intervention on Performance and Effectiveness of a Medical Emergency Team

Conditions
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Hospital Rapid Response Team

Intervention / Treatment
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* Other: A communication and team-working intervention


Participation Criteria
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Eligibility Criteria
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Inclusions - Medical Emergency Team (MET) calls Exclusion Criteria: Cancellation of the MET response prior to, or on arrival at, the location of activation Calls to patients < 18 years of age

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Medical Emergency Team<br>A communication and team-working initiative | Other: A communication and team-working intervention<br>* Medical Emergency Team (MET) briefings and formalised handover between MET staff and patient care teams<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Multiple Medical Emergency Team calls per patient admission |  | Measured at time of hospital discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mortality |  | At time of hospital discharge | 
| Mortality |  | At completion of Medical Emergency Team call | 
| ICU admission rate |  | At completion of Medical Emergency Team call | 
| ICU interventions |  | At completion of Medical Emergency Team call | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Non-technical skills, Crisis resource management, Medical Emergency Team, Rapid Response Team