Medical reviews before cardiac arrest, medical emergency call or unanticipated intensive care unit admission: their nature and impact on patient outcome

Abstract

Objective: To measure and describe the extent and consequences of documented medical patient reviews in the 24 hours before a cardiac arrest, medical emergency team (MET) call or an unanticipated intensive care unit admission ('event'), and the use of such reviews as a rapid response system performance measure. Design: Retrospective case-note and database review. Setting: Tertiary referral hospital, April-September, 2008. Participants: Adult inpatients who had an event and a preceding hospital length of stay > 24 hours. Main outcome measures: Hospital discharge status, ICU length of stay, not-for-resuscitation order. Results: 443 patients had 575 events (6.1% cardiac arrests, 68.7% MET calls, 25.2% ICU admissions) in the study period. A documented medical review preceded 561 (97.6%) events. Patients whose review was a home team review (HTR; ie, from a general ward) only were older than those with a critical care review (CCR) (70.2 v 63.6 years; P < 0.01). A critical care discharge (CCD) or CCR preceded 39.5% and HTR only, 57.9% of events. A CCD preceded 25.7% of cardiac arrests, 32.4% of MET calls, and 29.0% unanticipated ICU admissions. Patients with a CCR or CCD had lower hospital mortality than those with an HTR only (27.3% v 41.7%; P < 0.01), and shorter median ICU length of stay (2 [interquartile range, 1-3] v 2 [interquartile range, 1-6] days; P = 0.04). Conclusions: Medical reviews in the 24 hours before an adverse event are common. The type of medical review may influence patient outcome and thus may be a useful measure of rapid-response systems and critical care performance.