The medical emergency team call: a sentinel event that triggers goals of care discussion

Crit Care Med. 2014 Feb;42(2):322-7. doi: 10.1097/CCM.0b013e3182a27413.


Objective: Several studies have questioned the effectiveness of rapid-response systems when measured by outcomes such as decreased overall hospital mortality or cardiac arrest rates. We studied an alternative outcome of rapid-response system implementation, namely, its effect on goals of care and designation of do not resuscitate.

Design: Retrospective chart review.

Setting: Veterans Administration Hospital in New York City.

Subjects: All patients requiring a medical emergency team call.

Interventions: None

Measurements and main results: : Monthly hospital census and discharge data, death occurrences, and do-not-resuscitate order placements were collected over an 8-year pre-medical emergency team and 5-year post-medical emergency team period. All medical emergency team calls and subsequent transfers to a critical care unit were reviewed and correlated to the placement and timing of do-not-resuscitate orders. Interrupted time-series analysis was used to evaluate the impact of the medical emergency team implementation on the change in trend of do-not-resuscitate orders and the hospital mortality. A total of 390 medical emergency team calls were associated with 109 do-not-resuscitate orders (28%). Of the 209 medical emergency team calls (54%) resulting in transfer to a critical care unit, 66 were associated with do-not-resuscitate orders, 73% of which were obtained after transfer. The odds of becoming do not resuscitate for a patient going to the ICU after the medical emergency team call were 2.9 (95% CI, 1.6-5.5; p = 0.001) times greater than for patients staying on the floors after the medical emergency team call. The medical emergency team implementation significantly changed the trend of do-not-resuscitate orders (p < 0.001) but had no impact on hospital mortality rate (p = 0.638).

Conclusion: Implementation of a rapid-response system was associated with an increase in do-not-resuscitate order placement. As a sentinel event, medical emergency team activation and transfer to a critical care unit foster consideration of goals of care and frequently results in a transition to a palliative care strategy.

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Emergency Treatment / statistics & numerical data*
  • Hospital Mortality
  • Hospital Rapid Response Team / statistics & numerical data*
  • Humans
  • Middle Aged
  • Resuscitation Orders*
  • Retrospective Studies