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

• Sponsor: Lyell McEwin Hospital (Other)
• Overall Status: Completed
• CT.gov ID: NCT01551160
• Collaborator: University of Adelaide (Other)
• Enrollment: 1,500
• Location: 1
• Arm: 1
• Duration (Months): 26.1
• Patients Per Site Per Month: 57.6

Study Details

Study Description

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.

Condition or Disease	Intervention/Treatment	Phase
Hospital Rapid Response Team	Other: A communication and team-working intervention	N/A

Detailed Description

This investigation will comprise a mixed methods, before-and-after study. The particulars are:

Format:

1. Before intervention

2. Analysis of retrospective MET activity and patient outcome data

3. Surveying of staff for attitudes and perceptions of MET calls

4. Intervention

5. Twice-daily MET briefing meetings

6. Formalised handover process for MET calls resulting in patients remaining in their current clinical area

7. After intervention

8. Analysis of prospective MET activity and patient outcome data

9. 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

2. Per-hospital admission data includes: age, gender, admission diagnosis, admission type, length of stay and mortality

3. Per-MET call data includes: reason for call, location, duration of call, interventions performed, disposition and mortality

4. Perceptions and Attitudes

5. Ward staff question including around interactions with MET, involvement during MET calls, experience of repeat calling and reasons for repeat calling

6. MET questions including around interactions with ward staff, involvement of ward staff during calls and resolution of calls.

Study Design

• Study Type: Interventional
• Actual Enrollment: 1500 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Health Services Research
• Official Title: Impact of a Communication and Team-working Intervention on Performance and Effectiveness of a Medical Emergency Team
• Study Start Date: Jul 1, 2014
• Actual Primary Completion Date: Jul 1, 2016
• Actual Study Completion Date: Sep 1, 2016

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Medical Emergency Team A communication and team-working initiative	Other: A communication and team-working intervention; Medical Emergency Team (MET) briefings and formalised handover between MET staff and patient care teams

Outcome Measures

Primary Outcome Measures

1. Multiple Medical Emergency Team calls per patient admission [Measured at time of hospital discharge]

Secondary Outcome Measures

1. Mortality [At time of hospital discharge]

2. Mortality [At completion of Medical Emergency Team call]

3. ICU admission rate [At completion of Medical Emergency Team call]

4. ICU interventions [At completion of Medical Emergency Team call]

Other Outcome Measures

1. Perceptions of Interactions between Medical Emergency Team staff and patient care teams [1 year]

   Both Medical Emergency Team staff and patient care teams will be surveyed separately

Eligibility Criteria

Criteria

• Ages Eligible for Study: 18 Years and Older
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

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

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Lyell McEwin Hospital	Elizabeth Vale	South Australia	Australia	5112

Sponsors and Collaborators

• Lyell McEwin Hospital
• University of Adelaide

Investigators

• Principal Investigator: Richard Chalwin, FCICM, Lyell McEwin Hospital

Study Documents (Full-Text)

None provided.

More Information

Publications

• 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.

• Responsible Party: Dr Richard Chalwin, Principal Investigator, Lyell McEwin Hospital
• ClinicalTrials.gov Identifier: NCT01551160
• Other Study ID Numbers: RPC1001
• First Posted: Mar 12, 2012
• Last Update Posted: Nov 25, 2016
• Last Verified: Nov 1, 2016

• Individual Participant Data (IPD) Sharing Statement: No
• Plan to Share IPD: No
• Keywords provided by Dr Richard Chalwin, Principal Investigator, Lyell McEwin Hospital: Non-technical skills; Crisis resource management; Medical Emergency Team; Rapid Response Team
• Additional relevant MeSH terms: Emergencies

Study Results

No Results Posted as of Nov 25, 2016