Introduction of an obstetric-specific medical emergency team for obstetric crises: Implementation and experience
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. American journal of obstetrics and gynecology
(Impact Factor: 4.7).
05/2008; 198(4):367.e1-7. DOI: 10.1016/j.ajog.2007.06.072
We describe the implementation and experience with adding an obstetric-specific medical emergency team (called Condition O for obstetric crisis) to an existing rapid response system at Magee-Womens Hospital.
In response to deficits identified during patient safety review of adverse obstetric events in 2004 and 2005, the hospital administration decided to add a crisis team with expertise specifically designed for maternal and/or fetal crises.
During the first 6 months, staff rarely called Condition O (14 per 10,000 obstetric admissions). After reeducation efforts, use of Condition O increased to 62 per 10,000 obstetric admissions during 2006.
We outline our hospital's experience with implementation, efforts to address low utilization, and 1.5 years of Condition O event data. Condition O is a work in progress. In light of this, we discuss the challenges of measuring its patient safety outcome, considerations for team size and composition, and our efforts to determine an optimal Condition O rate.
Available from: Pei Shan Lim
- "The emergency team is alerted via a paging system simultaneously. In dire emergency such as massive PPH, this system has successfully delivered early interventions hence improving maternal outcomes (Gosman et al., 2008). A delay in intervention of 20 minutes or more had led to a poorer outcome. "
- "The World Health Organization (WHO) estimates that obstetric hemorrhage complicates 10.5% of all live births in the world. Furthermore, 28% of all direct maternal deaths are directly attributable to hemorrhage, with massive obstetric hemorrhage being a major risk factor for severe maternal morbidity and mortality. "
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ABSTRACT: The medical emergency team (MET) system was introduced successfully worldwide. With the exception of a few research publications, most of the described teams are based on patients' medical rather than obstetric management. The objective of this study was to review literature on the outcome of obstetric MET implementation.
Systematic review has been done through searching MEDLINE, the Cochrane Library, relevant articles references, and contact with experts. The author and one other researcher independently selected literature on the establishment or implementation of obstetric MET. There were no restrictions on language, sample size, type of publication, or duration of follow up.
THREE PUBLICATIONS WERE IDENTIFIED: Catanzarite et al., Gosman et al., and Skupski et al. They were heterogeneous in terms of the method of implementation and the outcomes discussed. None of them discussed obstetric MET implementation in developing countries.
In the literature, there is a lack of reporting and probably of implementation of Obstetrics METs. Therefore, there is a need for more standardized experiences and reports on the implementation of various types of Obstetrics METs. We propose here a design for Obstetrics METs to be implemented in developing countries, aiming to reduce maternal mortality and morbidity resulting from obstetric hemorrhage.
Available from: Jack Chen
- "These systems have now been widely adopted internationally    . They have been extended to cover pediatric     , obstetric   , and emergency department patients [16-19]. Within these systems, nursing and/or medical staff can call an emergency team based on prespecified vital sign abnormalities ( " triggers " ) or because they believe the patient is at risk of a serious adverse event ( " worried " criterion). "
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ABSTRACT: The purpose of the study was to examine triggers for emergency team activation in hospitals with or without a medical emergency team (MET) system.
Within a cluster randomized controlled trial examining the effect of introducing a MET system, we recorded the triggers for emergency team activation. We compared the proportion and rate of such triggers in hospitals with or without a MET system and in relation to type of hospital, type of patient ward, and time of day.
In control hospitals, the most common trigger for emergency team activation was a decrease in Glasgow Coma Score by 2 or more points (45.6%), whereas in MET hospitals, it was the fact that staff members were "worried" or the call occurred despite the lack of a "specified reason" (39.3%). In particular, MET hospitals were 35 times more likely to make a call because of staff being "worried" about the patient (14.1% vs 0.4%, P < .001). Control hospitals were also significantly more likely to call an emergency team because of a deteriorating respiratory (P = .003) or pulse (P < .001) rate, more calls had at least 3 triggers for activation (20.8% vs 10.2%, P = .036), and the average number of triggers per call was significantly higher (P = .013). Nonmetropolitan hospitals were more likely to call an emergency team because of respiratory rate abnormalities (33.6% vs 23.2%, P = .015). Coronary care unit calls were more likely to be triggered by abnormalities in pulse rate and systolic blood pressure, and more calls occurred during the period from 6:00 am to noon.
In MET hospitals, more emergency team calls are triggered because staff members are worried about the patient; and fewer calls have multiple triggers. Type of hospital, type of ward, and time of day also affect the nature and frequency of triggers for emergency team activation.
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