Eric B Milbrandt

Findings of the First Consensus Conference on Medical Emergency Teams

Background:Studies have established that physiologic instability and services mismatching precede adverse events in hospitalized patients. In response to these considerations, the concept of a Rapid Response System (RRS) has emerged. The responding team is commonly known as a medical emergency team (MET), rapid response team (RRT), or critical care outreach (CCO). Studies show that an RRS may improve outcome, but questions remain regarding the benefit, design elements, and advisability of implementing a MET system. Methods:In June 2005 an International Conference on Medical Emergency Teams (ICMET) included experts in patient safety, hospital medicine, critical care medicine, and METs. Seven of 25 had no experience with an RRS, and the remainder had experience with one of the three major forms of RRS. After preconference telephone and e-mail conversations by the panelists in which questions to be discussed were characterized, literature reviewed, and preliminary answers created, the panelists convened for 2 days to create a consensus document. Four major content areas were addressed: What is a MET response? Is there a MET syndrome? What are barriers to METS? How should outcome be measured? Panelists considered whether all hospitals should implement an RRS. Results:Patients needing an RRS intervention are suddenly critically ill and have a mismatch of resources to needs. Hospitals should implement an RRS, which consists of four elements: an afferent, “crisis detection” and “response triggering” mechanism; an efferent, predetermined rapid response team; a governance/administrative structure to supply and organize resources; and a mechanism to evaluate crisis antecedents and promote hospital process improvement to prevent future events.

Costs associated with delirium in mechanically ventilated patients.

ObjectiveTo determine the costs associated with delirium in mechanically ventilated medical intensive care unit patients. DesignProspective cohort study. SettingA tertiary care academic hospital. PatientsPatients were 275 consecutive mechanically ventilated medical intensive care unit patients. InterventionsWe prospectively examined patients for delirium using the Confusion Assessment Method for the Intensive Care Unit. Measurements and Main ResultsDelirium was categorized as “ever vs. never” and by a cumulative delirium severity index. Costs were determined from individual ledger-level patient charges using cost-center-specific cost-to-charge ratios and were reported in year 2001 U.S. dollars. Fifty-one of 275 patients (18.5%) had persistent coma and died in the hospital and were excluded from further analysis. Of the remaining 224 patients, delirium developed in 183 (81.7%) and lasted a median of 2.1 (interquartile range, 1–3) days. Baseline demographics were similar between those with and without delirium. Intensive care unit costs (median, interquartile range) were significantly higher for those with at least one episode of delirium (

The epidemiology of mechanical ventilation use in the United States

22,346,

Haloperidol use is associated with lower hospital mortality in mechanically ventilated patients.

15,083–

Growth of intensive care unit resource use and its estimated cost in Medicare

35,521) vs. those with no delirium (

Understanding the potential role of statins in pneumonia and sepsis

13,332,

DIFFERENCES IN IMMUNE RESPONSE MAY EXPLAIN LOWER SURVIVAL AMONG OLDER MEN WITH PNEUMONIA

8,837–

Bench-to-bedside review: Critical illness-associated cognitive dysfunction – mechanisms, markers, and emerging therapeutics

21,471, p < .001). Total hospital costs were also higher in those who developed delirium (

Do hospitals provide lower quality of care to black patients for pneumonia

41,836,

Prevalence and Significance of Coagulation Abnormalities in Community-Acquired Pneumonia

22,782–