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

Hospital Rapid Response Team Clinical Trial

— IMPACT  

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01551160
• Other study ID #: RPC1001
• Status: Completed
• Phase: N/A
• First received: March 4, 2012
• Last updated: November 23, 2016
• Start date: July 2014
• Est. completion date: September 2016

Study information

• Verified date: November 2016
• Source: Lyell McEwin Hospital
• Contact: n/a
• Is FDA regulated: No
• Health authority: Australia: Human Research Ethics Committee
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1500
• Est. completion date: September 2016
• Est. primary completion date: July 2016
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

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 Design

Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Health Services Research

Related Conditions & MeSH terms

• Emergencies
• Hospital Rapid Response Team

Intervention

Other:
• A communication and team-working intervention
Medical Emergency Team (MET) briefings and formalised handover between MET staff and patient care teams

Locations

Country	Name	City	State
Australia	Lyell McEwin Hospital	Elizabeth Vale	South Australia

Sponsors (2)

Lead Sponsor	Collaborator
Lyell McEwin Hospital	University of Adelaide

Country where clinical trial is conducted

Australia, 

References & Publications (1)

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. Review. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	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	No
Primary	Multiple Medical Emergency Team calls per patient admission		Measured at time of hospital discharge	No
Secondary	Mortality		At time of hospital discharge	Yes
Secondary	Mortality		At completion of Medical Emergency Team call	Yes
Secondary	ICU admission rate		At completion of Medical Emergency Team call	No
Secondary	ICU interventions		At completion of Medical Emergency Team call	No