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Gupta S, Tiruvoipati R, Balachandran M, Bolton G, Pratt N, Molloy J, Paul E, Irving A. A propensity matched cost analysis of medical emergency team calls led by nurse practitioners versus intensive care registrars. Intensive Crit Care Nurs 2024; 86:103819. [PMID: 39255615 DOI: 10.1016/j.iccn.2024.103819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/26/2024] [Accepted: 08/27/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVES Nurse practitioner-led MET calls have been shown to improve clinical outcomes versus ICU registrar-led MET calls. However, the cost implications of a nurse practitioner-led MET call system is not known. We conducted cost analysis from the healthcare service perspective to compare the costs of nurse practitioner- and ICU registrar-led MET calls. RESEARCH METHODOLOGY A retrospective study of MET calls between 1 June 2016 and 9 March 2018 including patients with first MET call during their hospital admission. The cost analysis compared MET calls attended by nurse practitioners against those attended by ICU registrars. MAIN OUTCOME MEASURES Inpatient costs for nurse practitioner- and ICU registrar-led MET calls. RESULTS 1,343 MET calls were included in the full dataset with a mean cost per ICU registrar-led MET calls and nurse practitioner led MET calls of AU$19,836 (95 % CI: AU$15,778 - AU$23,895) versus AU$16,404 (95 % CI: AU$14,988 - AU$17,820) respectively and a difference of AU$3,432 (95 % CI: -AU$38 - AU$6,903, p = 0.053). In the propensity-score matched analysis, the mean cost per ICU registrar-led MET calls and nurse practitioner led MET calls was AU$19,009 (95 % CI: AU$15,439 - AU$22,578) and AU$13,937 (95 % CI: AU$12,038 - AU$15,835) respectively, with a difference of AU$5,072 (95 % CI: AU$1,061 - AU$9,082, p = 0.013). A 24-hour nurse practitioners-led MET call service would break even at 101 MET calls leading to ICU admissions per year. CONCLUSION Nurse practitioners-led MET calls saved significant costs compared to ICU registrar-led MET calls. Assuming that the difference in costs is due to shorter ICU length of stay, a health service that receives more than 101 MET calls leading to ICU admissions per year can save costs with a 24-hour nurse practitioner-led MET call service. IMPLICATIONS FOR CLINICAL PRACTICE This study helps in identifying the healthcare services where nurse practitioners -led MET systems could be implemented to be cost saving from health service perspective.
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Affiliation(s)
- Sachin Gupta
- Department of Intensive Care Medicine, Peninsula Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Peninsula Health, Melbourne, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | | | - Gaby Bolton
- Department of Intensive Care Medicine, Peninsula Health, Melbourne, Australia
| | - Naomi Pratt
- Department of Intensive Care Medicine, Peninsula Health, Melbourne, Australia
| | - Jo Molloy
- Department of Intensive Care Medicine, Peninsula Health, Melbourne, Australia
| | - Eldho Paul
- ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Adam Irving
- Centre for Heath Economics, Monash Business School, Monash University, Caulfield East, VIC 3145, Australia
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Satyavolu R, Ruknuddeen MI, Soar N, Edwards SM. Dosage and clinical outcomes of medical emergency team and conventional referral mediated unplanned intensive care admissions. J Intensive Care Soc 2023; 24:178-185. [PMID: 37260436 PMCID: PMC10227895 DOI: 10.1177/17511437211060157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Background: Unplanned intensive care unit (ICU) admission occurs via activation of medical emergency team (MET) and conventional ICU referral (CIR), i.e., ICU consultation. We aimed to compare the dosage, association with unplanned ICU admissions and hospital mortality between MET and CIR systems. Methods: We performed a retrospective, single centre observational study on unplanned ICU admissions from hospital wards between July 2017 and June 2018. We evaluated the dosage (expressed per 1000 admissions) and association of CIR and MET system with unplanned ICU admission using Chi-square test. The relationship (unadjusted and adjusted to Australia and New Zealand risk of death (ANZROD) and lead time) between unplanned ICU admission pathway (MET vs CIR) and hospital mortality was tested by binary logistic regression analysis [Odds ratio (OR) with 95% confidence interval (CI)]. Results: Out of 38,628 patients hospitalised, 679 had unplanned ICU admission (2%) with an ICU admission rate of 18 per 1000 ward admissions. There were 2153 MET and 453 CIR activations, producing a dosage of 56 and 12 per 1000 admissions, respectively. Higher unplanned ICU admission was significantly associated with CIR compared to MET activation (324/453 (71.5%) vs 355/2153 (16.5%) p < 0.001). On binary logistic regression, MET system was significantly associated with higher hospital mortality on unadjusted analysis (OR 1.65 (95% CI: 1.09-2.48) p = 0.02) but not after adjustment with ANZROD and lead time (OR 1.15 (95% CI: 0.71-1.86), p = 0.58). Conclusions: Compared to CIR, MET system had higher dosage but lower frequency of unplanned ICU admissions and lacked independent association with hospital mortality.
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Affiliation(s)
| | | | - Natalie Soar
- Intensive Care Unit, Lyell Mc Ewin Hospital, Elizabeth Vale, Australia
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Karpati PC. From Asclepius to medical emergency teams. Minerva Anestesiol 2023; 89:4-6. [PMID: 36745116 DOI: 10.23736/s0375-9393.22.16974-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Peter C Karpati
- Weymouth Street Hospital, London, UK - .,London Hyperbaric Unit, Whipps Cross Hospital, Barts Health NHS Trust, London, UK -
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Baugh CW, Sodickson AD, Kivlehan SM, Chen PC, Perencevich ML, Jesudian AB. A Novel Multidisciplinary Team Activation for Patients with Severe Gastrointestinal Bleeding: Creation of the Code GI Bleed Protocol. Clin Exp Gastroenterol 2023; 16:55-58. [PMID: 37131985 PMCID: PMC10149094 DOI: 10.2147/ceg.s404247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/18/2023] [Indexed: 05/04/2023] Open
Abstract
Patients with gastrointestinal (GI) bleeding present to the emergency department (ED) with a wide spectrum of illness severity. Among the most critically ill patients, comorbidities and other risk factors, such as liver disease and anticoagulation, can complicate their management. These patients are resource-intensive to stabilize and resuscitate, often requiring the continuous attention of multiple ED staff members along with rapid mobilization of specialty care. At a tertiary care hospital with the ability to provide definitive care for the most critically ill patients with GI bleeding, we introduced a multi-disciplinary team activation pathway to bring together specialists to immediately respond to the ED. We designed a Code GI Bleed pathway to expedite hemodynamic stabilization, diagnostics, source control, and timely disposition out of the ED to the intensive care unit or relevant procedural area of the hospital.
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Affiliation(s)
- Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Correspondence: Christopher W Baugh, Brigham and Women’s Hospital, Department of Emergency Medicine, 75 Francis Street, Neville House 2 Floor, Boston, MA, 02115, USA, Tel +1 617-732-8192, Fax +1 617-264-6848, Email
| | - Aaron D Sodickson
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul C Chen
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Molly L Perencevich
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Arun B Jesudian
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
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Gong XY, Wang YG, Shao HY, Lan P, Yan RS, Pan KH, Zhou JC. A rapid response team is associated with reduced overall hospital mortality in a Chinese tertiary hospital: a 9-year cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:317. [PMID: 32355761 PMCID: PMC7186685 DOI: 10.21037/atm.2020.02.147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Although the evidence for its effectiveness remains uncertainty, rapid response systems are implemented across many hospitals across the world. Increasingly, hospitals in China have recently started to adopt a medical emergency or rapid response team (RRT). Hence, we aimed to determine whether the implementation of an RRT in Chinese hospitals also improved outcomes. Methods Our hospital is a Joint Commission International (JCI) accredited, tertiary teaching hospital with 1,200 beds. We conducted a retrospective cohort study comparing 60 months after the implementation of the RRT (January 1, 2013, to December 31, 2017) and 36 months before implementation (January 1, 2009, to December 31, 2011). The outcomes included the overall hospital mortality and incidence of codes. Results We analyzed 144,673 non-obstetric hospital admissions and 1,269,621 patient days in the control period and 348,687 non-obstetric hospital admissions and 2,361,913 patient days after the RRT implementation. The RRT was activated 834 times (2.39 calls per 1,000 patients and 0.35 call per 1,000 patient-days). There was no difference in the code rate (0.23 vs. 0.17 per 1,000 patient days, P=0.379) between the two periods. Although the hospital mortality had remained stable around 3.0 per 1,000 patients from 2009 to 2011, there was a significant 40% decrease of overall hospital mortality from 2.95 to 1.77 per 1,000 non-obstetric patients after the implementation of RRT (P=0.001), and the annual mortality showed a consistent decrease (P=0.037 for the trend). Moreover, the increase of RRT activations was significantly correlated with the decrease of hospital mortality (P=0.025). Conclusions RRT implementation was associated with reduced overall hospital mortality in a Chinese tertiary hospital.
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Affiliation(s)
- Xiao-Yan Gong
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Yong-Gang Wang
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Hong-Yi Shao
- Department of Emergency Intensive Care Medicine, Affiliated Central Hospital, Shaoxing University, Shaoxing 312030, China
| | - Peng Lan
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Ru-Shuang Yan
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Kong-Han Pan
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Jian-Cang Zhou
- Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
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Choi MS, Lee DS, Park CM. Evaluation of Medical Emergency Team Activation in Surgical Wards. JOURNAL OF ACUTE CARE SURGERY 2019. [DOI: 10.17479/jacs.2019.9.2.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Smith RJ, Reid DA, Santamaria JD. Frailty is associated with reduced prospect of discharge home after in‐hospital cardiac arrest. Intern Med J 2019; 49:978-985. [DOI: 10.1111/imj.14159] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Roger J. Smith
- Department of Critical Care MedicineSt Vincent’s Hospital Melbourne Victoria Australia
| | - David A. Reid
- Department of Critical Care MedicineSt Vincent’s Hospital Melbourne Victoria Australia
| | - John D. Santamaria
- Department of Critical Care MedicineSt Vincent’s Hospital Melbourne Victoria Australia
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de Grooth HJ, Girbes AR, Loer SA. Early warning scores in the perioperative period. Curr Opin Anaesthesiol 2018; 31:732-738. [DOI: 10.1097/aco.0000000000000657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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