Clinical trial NCT01551160: Impact of a Communication and Team-working Intervention on Performance and Effectiveness of a Medical Emergency Team
Official title: Impact of a Communication and Team-working Intervention on Performance and Effectiveness of a Medical Emergency Team
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Hospital Rapid Response Team
Keywords: Non-technical skills
Crisis resource management
Medical Emergency Team
Rapid Response Team
Lead sponsor: Lyell McEwin Hospital
Sponsor class: OTHER_GOV
Collaborators: name: University of Adelaide
First posted: 2012-03-12
Enrollment: 1500
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: This investigation will comprise a mixed methods, before-and-after study. The particulars are:

Format:

1. Before intervention

   1. Analysis of retrospective MET activity and patient outcome data
   2. Surveying of staff for attitudes and perceptions of MET calls
2. Intervention

   1. Twice-daily MET briefing meetings
   2. Formalised handover process for MET calls resulting in patients remaining in their current clinical area
3. After intervention

   1. Analysis of prospective MET activity and patient outcome data
   2. 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:

1. 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.
2. 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:

1. Characteristics and Outcomes

   1. Per-hospital admission data includes: age, gender, admission diagnosis, admission type, length of stay and mortality
   2. Per-MET call data includes: reason for call, location, duration of call, interventions performed, disposition and mortality
2. Perceptions and Attitudes

   1. Ward staff question including around interactions with MET, involvement during MET calls, experience of repeat calling and reasons for repeat calling
   2. MET questions including around interactions with ward staff, involvement of ward staff during calls and resolution of calls.

Eligibility criteria: 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

Primary outcomes:
measure: Multiple Medical Emergency Team calls per patient admission
timeFrame: Measured at time of hospital discharge
Secondary outcomes:
measure: Mortality
timeFrame: At time of hospital discharge
measure: Mortality
timeFrame: At completion of Medical Emergency Team call
measure: ICU admission rate
timeFrame: At completion of Medical Emergency Team call
measure: ICU interventions
timeFrame: At completion of Medical Emergency Team call
Other outcomes:
measure: Perceptions of Interactions between Medical Emergency Team staff and patient care teams
timeFrame: 1 year
Locations:
city: Elizabeth Vale
country: Australia
facility: Lyell McEwin Hospital
state: South Australia
Study officials:
affiliation: Lyell McEwin Hospital
name: Richard Chalwin, FCICM
role: PRINCIPAL_INVESTIGATOR
References:
citation: Chalwin RP, Flabouris A. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams. Intern Med J. 2013 Sep;43(9):962-9. doi: 10.1111/imj.12172.
citation: Chalwin R, Giles L, Salter A, Kapitola K, Karnon J. Re-designing a rapid response system: effect on staff experiences and perceptions of rapid response team calls. BMC Health Serv Res. 2020 May 29;20(1):480. doi: 10.1186/s12913-020-05260-z.