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

NCT ID: NCT01551160

Last Updated: 2016-11-25

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 1500 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2014-07-31
• Study Completion Date: 2016-09-30

Brief Summary

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.

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.

Conditions

Hospital Rapid Response Team

Keywords

Non-technical skills; Crisis resource management; Medical Emergency Team; Rapid Response Team

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Medical Emergency Team

A communication and team-working initiative

Group Type: EXPERIMENTAL

A communication and team-working intervention

Intervention Type: OTHER

Medical Emergency Team (MET) briefings and formalised handover between MET staff and patient care teams

Interventions

A communication and team-working intervention

Medical Emergency Team (MET) briefings and formalised handover between MET staff and patient care teams

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• 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

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Adelaide

OTHER

Sponsor Role: collaborator

Lyell McEwin Hospital

OTHER_GOV

Sponsor Role: lead

Responsible Party

Dr Richard Chalwin

Principal Investigator

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Richard Chalwin, FCICM

Role: PRINCIPAL_INVESTIGATOR

Lyell McEwin Hospital

Locations

Lyell McEwin Hospital

Elizabeth Vale, South Australia, Australia

Countries

Australia

References

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.

Reference Type: BACKGROUND

PMID: 23611153 (View on PubMed)

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.

Reference Type: DERIVED

PMID: 32471422 (View on PubMed)

Other Identifiers

RPC1001

Identifier Type: -

Identifier Source: org_study_id