R. Scott Braithwaite

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.

Estimating Hip Fracture Morbidity, Mortality and Costs

OBJECTIVES:  To estimate lifetime morbidity, mortality, and costs from hip fracture incorporating the effect of deficits in activities of daily living.

What Does the Value of Modern Medicine Say About the

Background:In the United States,

50,000 per Quality-Adjusted Life-Year Decision Rule?

50,000 per Quality-Adjusted Life-Year (QALY) is a decision rule that is often used to guide interpretation of cost-effectiveness analyses. However, many investigators have questioned the scientific basis of this rule, and it has not been updated. Methods:We used 2 separate approaches to investigate whether the

Survival From In-Hospital Cardiac Arrest During Nights and Weekends

50,000 per QALY rule is consistent with current resource allocation decisions. To infer a lower bound for the decision rule, we estimated the incremental cost-effectiveness of recent (2003) versus pre-“modern era” (1950) medical care in the United States. To infer an upper bound for the decision rule, we estimated the incremental cost-effectiveness of unsubsidized health insurance versus self-pay for nonelderly adults (ages 21–64) without health insurance. We discounted both costs and benefits, following recommendations of the Panel on Cost-Effectiveness in Health and Medicine. Results:Our base case analyses suggest that plausible lower and upper bounds for a cost-effectiveness decision rule are

Meta-analysis of Vascular and Neoplastic Events Associated with Tamoxifen

183,000 per life-year and

Systematic review: noninvasive testing for Chlamydia trachomatis and Neisseria gonorrhoeae.

264,000 per life-year, respectively. Our sensitivity analyses widen the plausible range (between

A temporal and dose-response association between alcohol consumption and medication adherence among veterans in care.

95,000 per life-year saved and

Adherence, virological and immunological outcomes for HIV-infected veterans starting combination antiretroviral therapies

264,000 per life-year saved when we considered only health cares impact on quantity of life, and between

Impact of cigarette smoking on mortality in HIV-positive and HIV-negative veterans.

109,000 per QALY saved and