Utilize este identificador para referenciar este registo: http://hdl.handle.net/10400.16/2158
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degois.publication.firstPage33pt_PT
degois.publication.issue1pt_PT
degois.publication.locationEnglandpt_PT
degois.publication.titleScandinavian Journal of Trauma, Resuscitation and Emergency Medicinept_PT
dc.relation.publisherversionhttps://sjtrem.biomedcentral.com/articles/10.1186/s13049-016-0222-7pt_PT
dc.contributor.authorSilva, R.-
dc.contributor.authorSaraiva, M.-
dc.contributor.authorCardoso, T.-
dc.contributor.authorAragão, I.-
dc.date.accessioned2017-07-24T14:24:17Z-
dc.date.available2017-07-24T14:24:17Z-
dc.date.issued2016-03-22-
dc.identifier.citationScand J Trauma Resusc Emerg Med. 2016 Mar 22;24:33pt_PT
dc.identifier.issn1757-7241-
dc.identifier.urihttp://hdl.handle.net/10400.16/2158-
dc.description.abstractBACKGROUND: The creation, implementation and effectiveness of a medical emergency team (MET) in every hospital is encourage and supported by international bodies of quality certification. Issues such as what is the best composition of the team or the interventions performed by the MET at the scene and the immediate outcomes of the patients after MET intervention have not yet been sufficiently explored. The purpose of the study is to characterize MET actions at the scene and the immediate patient outcome. METHODS: Retrospective cohort study, at a tertiary care, university-affiliated, 600-bed hospital, in the north of Portugal, over two years. RESULTS: There were 511 MET activations: 389 (76%) were for inpatients. MET activation rate was 8.6/1,000 inpatients. The main criteria for activation were airway threatening in 143 (36.8%), concern of medical staff in 121 (31.1%) and decrease in GCS > 2 in 98 (25.2%) patients; MET calls for cardiac arrest occurred in 68 patients (17.5%). The median (IQR) time the team stayed at the scene was 35 (20-50) minutes. At the scene, the most frequent actions were related to airway and ventilation, namely oxygen administration in 145 (37.3%); in circulation, fluid were administered in 158 (40.6%); overall medication was administered in 185 (47.5%) patients. End-of-life decisions were part of the MET actions in 94 (24.1%) patients. At the end of MET intervention, 73 (18.7%) patients died at the scene, 190 (60.7%) stayed on the ward and the remaining 123 patients were transferred to an increased level of care. Crude hospital mortality rate was 4.1% in the 3 years previously to MET implementation and 3.6% in the following 3 years (p < 0.001). DISCUSSION: During the study period, the rate of activation for medical inpatients was significantly higher than that for surgical inpatients. In our hospital, there is no 24/7 medical cover on the wards, with the exception of high-dependency and intensive care units; assuming that the number of unplanned admissions and chronic ill patients is greater in medical wards that could explain the difference found, which prompts the implementation of a 24/7 ward residence. The team stayed on site for half an hour and during that time most of the actions were simple and nurse-driven, but in one third of all activations medical actions were taken, and in a forth (24%) end-of-life decisions made, reinforcing the inclusion of a doctor in the MET. A significant decrease in overall hospital mortality rate was observed after the implementation of the MET. CONCLUSIONS: The composition of our MET with an ICU doctor and nurse was reinforced by the need of medical actions in more than half of the situations (either clinical actions or end-of-life decisions). After MET implementation there was a significant decrease in hospital mortality. This study reinforces the benefit of implementing an ICU-MET team.pt_PT
dc.description.sponsorshipThis work was supported by Centro Hospitalar do Porto (Research Grant CHP 2011)pt_PT
dc.language.isoengpt_PT
dc.publisherBioMed Centralpt_PT
dc.rightsopenAccesspt_PT
dc.subjectActions at the scenept_PT
dc.subjectActivation criteriapt_PT
dc.subjectCardiac Arrest Teampt_PT
dc.subjectEfferent limbpt_PT
dc.subjectImmediate outcomept_PT
dc.subjectMedical Emergency Teampt_PT
dc.subjectRapid Response Teampt_PT
dc.titleMedical Emergency Team: How do we play when we stay? Characterization of MET actions at the scenept_PT
dc.typearticlept_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.peerreviewedyespt_PT
degois.publication.volume24pt_PT
dc.identifier.doi10.1186/s13049-016-0222-7pt_PT
Aparece nas colecções:SCIP2 - Artigos publicados em revistas indexadas na Medline

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