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      Long term survival following a medical emergency team call at an Australian regional hospital

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          Abstract

          Objective: To investigate the long term survival of medical emergency team (MET) patients at an Australian regional hospital and describe associated patient and MET call characteristics.

          Design: Retrospective cohort study. Data linkage to the statewide death registry was performed to allow for long term survival analysis, including multivariable Cox proportional hazards regression and production of Kaplan–Meier survival curves.

          Setting: A large Australian regional hospital.

          Participants: Adult patients who received a MET call from 1 July 2012 to 3 March 2020.

          Main outcome measures: Survival to 30, 90 and 180 days; one year; and 5-years after index MET call.

          Results: The study included 6499 eligible patients. The cohort median age was 71 years, and 52.4% of the patients were female. Surgical (39.6%) and medical (36.9%) patients comprised most of the cohort. Thirty-day survival was 86.5% one-year survival was 66.1%. Among patients aged < 75 years, factors independently associated with significantly higher long term mortality included age (hazard ratio [HR], 3.26 [95% CI, 2.63–4.06]; for patients aged 65-74 v 18–54 years), male sex (HR, 0.71 [95% CI, 0.61–0.83]; for females) and pre-existing limitation of medical therapy (HR, 2.76; 95% CI, 2.28–3.35). Among patients aged ≥ 75 years, factors independently associated with significantly higher long term mortality included age (HR, 1.46 [95% CI, 1.29–1.65]; for patients aged ≥ 85 years), male sex (HR, 0.74 [95% CI, 0.66–0.83]; for females), and altered MET criteria (HR, 1.33; 95% CI, 1.03–1.71).

          Conclusions: Long term survival probabilities of MET call patients are affected by factors including age, sex, and limitation of medical therapy status. These data may be useful for clinicians conducting end-of-life discussions with patients.

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          Most cited references30

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          Rapid-response teams.

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            Findings of the first consensus conference on medical emergency teams.

            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. 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. 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.
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              Trajectories of disability in the last year of life.

              Despite the importance of functional status to older persons and their families, little is known about the course of disability at the end of life. We evaluated data on 383 decedents from a longitudinal study involving 754 community-dwelling older persons. None of the subjects had disability in essential activities of daily living at the beginning of the study, and the level of disability was ascertained during monthly interviews for more than 10 years. Information on the conditions leading to death was obtained from death certificates and comprehensive assessments that were completed at 18-month intervals after the baseline assessment. In the last year of life, five distinct trajectories were identified, from no disability to the most severe disability: 65 subjects had no disability (17.0%), 76 had catastrophic disability (19.8%), 67 had accelerated disability (17.5%), 91 had progressive disability (23.8%), and 84 had persistently severe disability (21.9%). The most common condition leading to death was frailty (in 107 subjects [27.9%]), followed by organ failure (in 82 subjects [21.4%]), cancer (in 74 subjects [19.3%]), other causes (in 57 subjects [14.9%]), advanced dementia (in 53 subjects [13.8%]), and sudden death (in 10 subjects [2.6%]). When the distribution of the disability trajectories was evaluated according to the conditions leading to death, a predominant trajectory was observed only for subjects who died from advanced dementia (67.9% of these subjects had a trajectory of persistently severe disability) and sudden death (50.0% of these subjects had no disability). For the four other conditions leading to death, no more than 34% of the subjects had any of the disability trajectories. The distribution of disability trajectories was particularly heterogeneous among the subjects with organ failure (from 12.2 to 32.9% of the subjects followed a specific trajectory) and frailty (from 14.0 to 27.1% of the subjects followed a specific trajectory). In most of the decedents, the course of disability in the last year of life did not follow a predictable pattern based on the condition leading to death. 2010 Massachusetts Medical Society
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                Author and article information

                Contributors
                Journal
                Crit Care Resusc
                Crit Care Resusc
                Critical Care and Resuscitation
                Elsevier
                1441-2772
                2652-9335
                19 October 2023
                06 June 2022
                19 October 2023
                : 24
                : 2
                : 163-174
                Affiliations
                [1 ]School of Rural Health, Monash University, Melbourne, VIC, Australia.
                [2 ]Intensive Care Unit, Bendigo Health, Bendigo, VIC, Australia.
                [3 ]Rural Clinical School, Bendigo campus, University of Melbourne, Bendigo, VIC, Australia.
                [4 ]Intensive Care Unit, Austin Health, Melbourne, VIC, Australia.
                [5 ]Alfred Health, Melbourne, VIC, Australia.
                Article
                S1441-2772(23)00094-7
                10.51893/2022.2.OA6
                10692633
                38045599
                3d5e9d78-15dc-4cb7-aea1-91ee736635a5
                © 2022 College of Intensive Care Medicine of Australia and New Zealand.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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