Impact of a Communication and Team-working Intervention on Performance and Effectiveness of a Medical Emergency Team (IMPACT)

Patients in hospital can have unexpected clinical emergencies. When this occurs the Medical Emergency Team (MET) are called with the intention of resolving the problem. Previous investigations have found that patients who have more than one call during their admission have worse outcomes than patients who only have one call. But it has not been established why.

The aim of this research will be to examine these repeated calls and why patients subject to them go on to have worse outcomes. A predictive model will be developed to identify potential sources of risk. One potential source is poor communication between health care providers. An intervention to improve communication around MET calls may provide benefit to patients and improve outcomes.

Study Overview

• Status: Completed
• Conditions: Hospital Rapid Response Team
• Intervention / Treatment: Other: A communication and team-working intervention

Detailed Description

This investigation will comprise a mixed methods, before-and-after study. The particulars are:

Format:

1. Before intervention

   1. Analysis of retrospective MET activity and patient outcome data
   2. Surveying of staff for attitudes and perceptions of MET calls

2. Intervention

   1. Twice-daily MET briefing meetings
   2. Formalised handover process for MET calls resulting in patients remaining in their current clinical area

3. After intervention

   1. Analysis of prospective MET activity and patient outcome data
   2. Surveying of staff for attitudes and perceptions of MET calls

Setting:

Lyell McEwin Hospital, a 300 bed, university-affiliated, tertiary, metropolitan hospital located in Adelaide, South Australia. It has comprehensive in-patient medical and surgical services including a Level 3 Intensive Care Unit.

Subjects:

1. Patients - adult in-patients attended by the MET during the study period. This will include patients attended more than once during an admission, as all calls will be a separate datapoint. It is also possible for patients to have more than one admission during the study period, so each admission will be considered discretely.
2. Staff - members of the hospital MET and ward staff that may call the MET. The MET composition is an ICU doctor, ICU nurse, medical registrar, intern and hospital manager. Due to rostering demands, this team is supplied from a pool of staff within each of the representative departments (approximately 10 ICU doctors, 30 ICU nurses, 30 medicine registrars, 36 interns and 8 duty managers).

Data Collection:

1. Characteristics and Outcomes

   1. Per-hospital admission data includes: age, gender, admission diagnosis, admission type, length of stay and mortality
   2. Per-MET call data includes: reason for call, location, duration of call, interventions performed, disposition and mortality

2. Perceptions and Attitudes

   1. Ward staff question including around interactions with MET, involvement during MET calls, experience of repeat calling and reasons for repeat calling
   2. MET questions including around interactions with ward staff, involvement of ward staff during calls and resolution of calls.

• Study Type: Interventional
• Enrollment (Actual): 1500
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Australia
  • South Australia
    • Elizabeth Vale, South Australia, Australia, 5112
      • Lyell McEwin Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusions

- Medical Emergency Team (MET) calls

Exclusion Criteria:

• Cancellation of the MET response prior to, or on arrival at, the location of activation
• Calls to patients < 18 years of age

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Medical Emergency Team; A communication and team-working initiative	Other: A communication and team-working intervention; Medical Emergency Team (MET) briefings and formalised handover between MET staff and patient care teams

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Multiple Medical Emergency Team calls per patient admission	Measured at time of hospital discharge

Secondary Outcome Measures

Outcome Measure	Time Frame
Mortality	At time of hospital discharge
Mortality	At completion of Medical Emergency Team call
ICU admission rate	At completion of Medical Emergency Team call
ICU interventions	At completion of Medical Emergency Team call

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceptions of Interactions between Medical Emergency Team staff and patient care teams	Both Medical Emergency Team staff and patient care teams will be surveyed separately	1 year

Collaborators and Investigators

• Sponsor: Lyell McEwin Hospital
• Collaborators: University of Adelaide
• Investigators: Principal Investigator: Richard Chalwin, FCICM, Lyell McEwin Hospital

Publications and helpful links

General Publications

• Chalwin RP, Flabouris A. Utility and assessment of non-technical skills for rapid response systems and medical emergency teams. Intern Med J. 2013 Sep;43(9):962-9. doi: 10.1111/imj.12172.
• Chalwin R, Giles L, Salter A, Kapitola K, Karnon J. Re-designing a rapid response system: effect on staff experiences and perceptions of rapid response team calls. BMC Health Serv Res. 2020 May 29;20(1):480. doi: 10.1186/s12913-020-05260-z.

Study record dates

Study Major Dates

• Study Start: July 1, 2014
• Primary Completion (Actual): July 1, 2016
• Study Completion (Actual): September 1, 2016

Study Registration Dates

• First Submitted: March 4, 2012
• First Submitted That Met QC Criteria: March 7, 2012
• First Posted (Estimate): March 12, 2012

Study Record Updates

• Last Update Posted (Estimate): November 25, 2016
• Last Update Submitted That Met QC Criteria: November 23, 2016
• Last Verified: November 1, 2016

More Information

Terms related to this study

• Keywords: Non-technical skills; Crisis resource management; Medical Emergency Team; Rapid Response Team
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: RPC1001

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No