The role of the medical emergency team in end-of-life care : a multicenter, prospective, observational study

Jones, Daryl A., Bagshaw, Sean M., Barrett, Jonathon, Bellomo, Rinaldo, Bhatia, Gaurav, Bucknall, Tracey K., Casamento, Andrew J., Duke, Graeme J., Gibney, Noel, Hart, Graeme K., Hillman, Ken M., Jaderling, Gabriella, Parmar, Ambica and Parr, Michael J. 2012, The role of the medical emergency team in end-of-life care : a multicenter, prospective, observational study, Critical care medicine, vol. 40, no. 1, pp. 98-103, doi: 10.1097/CCM.0b013e31822e9d50.

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Title The role of the medical emergency team in end-of-life care : a multicenter, prospective, observational study
Author(s) Jones, Daryl A.
Bagshaw, Sean M.
Barrett, Jonathon
Bellomo, Rinaldo
Bhatia, Gaurav
Bucknall, Tracey K.ORCID iD for Bucknall, Tracey K.
Casamento, Andrew J.
Duke, Graeme J.
Gibney, Noel
Hart, Graeme K.
Hillman, Ken M.
Jaderling, Gabriella
Parmar, Ambica
Parr, Michael J.
Journal name Critical care medicine
Volume number 40
Issue number 1
Start page 98
End page 103
Total pages 6
Publisher Lippincott Williams & Wilkins
Place of publication Baltimore, Md.
Publication date 2012-01
ISSN 0090-3493
Keyword(s) advanced care planning
do not resuscitate
end-of-life care planning
limitation of medical therapy
medical emergency team
not for resuscitation
rapid response system
Summary Objective: To investigate the role of medical emergency teams in end-of-life care planning.

Design: One month prospective audit of medical emergency team calls.

Setting: Seven university-affiliated hospitals in Australia, Canada, and Sweden.

Patients: Five hundred eighteen patients who received a medical emergency team call over 1 month.

Interventions: None.

Measurements and Main Results: There were 652 medical emergency team calls in 518 patients, with multiple calls in 99 (19.1%) patients. There were 161 (31.1%) patients with limitations of medical therapy during the study period. The limitation of medical therapy was instituted in 105 (20.3%) and 56 (10.8%) patients before and after the medical emergency team call, respectively. In 78 patients who died with a limitation of medical therapy in place, the last medical emergency team review was on the day of death in 29.5% of patients, and within 2 days in another 28.2%. Compared with patients who did not have a limitation of medical therapy, those with a limitation of medical therapy were older (80 vs. 66 yrs; p < .001), less likely to be male (44.1% vs. 55.7%; p .014), more likely to be medical admissions (70.8% vs. 51.3%; p < .001), and less likely to be admitted from home (74.5% vs. 92.2%, p < .001). In addition, those with a limitation of medical therapy were less likely to be discharged home (22.4% vs. 63.6%; p < .001) and more likely to die in hospital (48.4% vs. 12.3%; p < .001). There was a trend for increased likelihood of calls associated with limitations of medical therapy to occur out of hours (51.0% vs. 43.8%, p .089).

Conclusions: Issues around end-of-life care and limitations of medical therapy arose in approximately one-third of calls, suggesting a mismatch between patient needs for end-of-life care and resources at participating hospitals. These calls frequently occur in elderly medical patients and out of hours. Many such patients do not return home, and half die in hospital. There is a need for improved advanced care planning in our hospitals, and to confirm our findings in other organizations.
Language eng
DOI 10.1097/CCM.0b013e31822e9d50
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2012, The Society of Critical Care Medicine and Lippincott Williams & Wilkins
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Created: Tue, 10 Jan 2012, 13:21:12 EST by Jane Moschetti

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