Rescue Events in Medical and Surgical Patients: Impact of Patient, Nurse and Organzational Characteristics

Medical emergency teams (METs) were developed to more rapidly respond to changes in patient condition that might result in a preventable death. While effective, MET do not address events which precede the call for a response. Such information could provide direction for interventions that avert the need to initiate a MET response or identify the need to do so more quickly. This study examined differences in patient, nurse, and organizational characteristics for 108 MET calls involving patients on five medical and five surgical units in a tertiary care hospital. MET activations occurred more often on the 7AM-7PM shift than the 7PM-7AM shift (p¡Ü .007) for medical patients (p=.036) but not surgical patients. Of the 108 events, 44% were delayed events, defined as events with documented evidence in the medical record that pre-established criteria for calling the MET were present for > 30 minutes. More delays occurred on the 7PM-7AM shift (p=.012) for surgical patients (p=.036) but not medical patients. Delayed events were not significantly related to the number of medical or surgical patients the nurse was assigned (p=.608). However, there was a trend for more delays when more patients were assigned (4:1 = 21% vs 6:1= 43%). In a logistic regression model, the variables of shift (7AM, 7PM) and care on a unit designated for medical or surgical patients were significant predictors of delay. Shift was associated with a significance level of .009 and a 3.25 greater likelihood (95%CI, 1.34-7.9) of a delay occurring on the 7PM shift. Receiving care on a designated unit was associated with a significance level of .014 (OR, .07; 95%CI, .009-.579). These findings have implications for patient safety by demonstrating avoidable delays in responding to clinical deterioration. Study findings suggest that a combination of patient, nurse, and organizational characteristics influence the timely rescue of hospitalized patients