Gabriella Jäderling

The role of the medical emergency team in end-of-life care : a multicenter, prospective, observational study

Objective:To investigate the role of medical emergency teams in end-of-life care planning. Design:One month prospective audit of medical emergency team calls. Setting:Seven university-affiliated hospitals in Australia, Canada, and Sweden. Patients:Five hundred eighteen patients who received a medical emergency team call over 1 month. Interventions:None. Measurements and Main Results:There were 652 medical emergency team calls in 518 patients, with multiple calls in 99 (19.1%) patients. There were 161 (31.1%) patients with limitations of medical therapy during the study period. The limitation of medical therapy was instituted in 105 (20.3%) and 56 (10.8%) patients before and after the medical emergency team call, respectively. In 78 patients who died with a limitation of medical therapy in place, the last medical emergency team review was on the day of death in 29.5% of patients, and within 2 days in another 28.2%.Compared with patients who did not have a limitation of medical therapy, those with a limitation of medical therapy were older (80 vs. 66 yrs; p < .001), less likely to be male (44.1% vs. 55.7%; p = .014), more likely to be medical admissions (70.8% vs. 51.3%; p < .001), and less likely to be admitted from home (74.5% vs. 92.2%, p < .001). In addition, those with a limitation of medical therapy were less likely to be discharged home (22.4% vs. 63.6%; p < .001) and more likely to die in hospital (48.4% vs. 12.3%; p < .001). There was a trend for increased likelihood of calls associated with limitations of medical therapy to occur out of hours (51.0% vs. 43.8%, p = .089). Conclusions:Issues around end-of-life care and limitations of medical therapy arose in approximately one-third of calls, suggesting a mismatch between patient needs for end-of-life care and resources at participating hospitals. These calls frequently occur in elderly medical patients and out of hours. Many such patients do not return home, and half die in hospital. There is a need for improved advanced care planning in our hospitals, and to confirm our findings in other organizations.

ICU admittance by a rapid response team versus conventional admittance, characteristics, and outcome.

Objective:To evaluate characteristics and outcome of ICU patients admitted from general wards based on mode of admittance, via a rapid response team or conventional contact. Design:Observational prospective study. Setting:General ICU of a university hospital. Patients:A total of 694 admissions to ICU from general wards. Interventions:None. Measurements and Main Results:Between 2007 and 2009, two cohorts admitted to ICU from general wards were identified: those admitted by the rapid response team and those admitted in a conventional way. Patients admitted directly from the trauma room, the emergency department, operating room, other hospitals, or other ICUs were excluded. Of 694 admissions, 355 came through a rapid response team call. Rapid response team patients were older (p < 0.01), and they had more severe comorbidities, higher severity score (p < 0.01), and almost three times more often the diagnosis of severe sepsis (p < 0.01) than conventionally admitted patients. Rapid response team patients had higher ICU mortality and 30-day mortality with a crude odds ratio for mortality within 30 days of 1.57 (95% confidence interval 1.08–2.28). Adjusted for age and comorbidities however, the difference was no longer significant with an odds ratio of 1.11 (95% confidence interval 0.70–1.76). Conclusions:This study suggests that the rapid response team is an important system for identifying complex patients in need of intensive care. More than half of ICU admissions from the wards came through a rapid response team call. Compared with conventional admissions, rapid response team patients had a high proportion of characteristics that could be related to a worse prognosis. Severe sepsis at the wards was mainly detected by the rapid response team and was the most common admitting diagnosis among the rapid response team patients. When adjusted for confounding factors, outcome between the groups did not differ, supporting the use of rapid response systems to identify deteriorating ward patients.

Limitations of medical treatment among patients attended by the rapid response team

Rapid response teams (RRTs) are called to deteriorating ward patients in order to improve their outcome. The involvement of the team also in end‐of‐life care issues needs to be addressed. Our objective was to evaluate the RRT with focus on limitations of medical treatment (LOMT).

National Early Warning Score vs Rapid Response Team criteria—Prevalence, misclassification, and outcome

The purpose of this study was to examine the prevalence of deviating vital parameters in general ward patients using rapid response team (RRT) criteria and National Early Warning Score (NEWS), assess exam duration, correct calculation and classification of risk score as well as mortality and adverse events.

Setting Up a Standardized Process and Outcome Assessment Tool

Rapid response systems have evolved as a measure to improve patient safety by identifying deteriorating patients on general wards and addressing their needs at an early stage. This intervention is based on changing processes in order to change the outcomes of hospitalized patients, and evaluating the effects of such a complex system change can be challenging. In this chapter, we present the steps of implementation, data collection, and evaluation of rapid response systems

The influence of gender on ICU admittance

BackgroundWe assume that critically ill patients are admitted to an intensive care unit (ICU) based on their illness severity coupled with their co-morbidities. Patient attributes such as religion, nationality, socioeconomic class or gender are not relevant in this setting. We aimed to explore the association of patient gender with admission to the ICU amongst hospital physicians working in Sweden.MethodsPrimary outcome assessed was gender bias among respondents. Two different versions of an online survey, with eight patient cases, were sent to physicians in Sweden who within their field of specialty meet patients that could be eligible for intensive care. The versions of the survey were identical except that the patient gender in each case was exchanged between the two surveys. Depending on the respondent’s birthday (odd or even number) they were directed to one of the two surveys. At the end of each case the respondent was asked to answer if they thought that the patient needed ICU care, yes or no. The respondents were not told in advance about the design of the survey. The respondents were also asked to state their age, sex, field of specialty, size of hospital and title.ResultsOf 1426 respondents, 679 and 747 answered survey 1 and 2, respectively. Overall, there were no significant differences in willingness to admit in between cases describing a man or woman in the physician responses.DiscussionAnesthesiology/intensive care physicians more often choose to admit patients to the ICU compared to all other specialties. Female physicians tended to be more willing to admit patients, regardless of patient gender, than their male counterparts.ConclusionsUsing a survey, with eight cases differing only with regards to the gender of the patient, we demonstrate an absence of a gender bias among Swedish hospital physicians.