Medical emergency team: a review of the literature

Background: A medical emergency team (MET) comprises of a team of doctors and nurses with advanced life support skills, which are hospital based, who respond to emergency calls following a deterioration in a patient’s clinical condition. The role and contribution of such approaches promoting the early recognition and intervention of these vulnerable patients demands critical appraisal. Aim: To investigate the contribution of medical emergency teams and whether there are clinical antecedents evident prior to the triggering the MET system. The paper will also discuss factors influencing effective utilization and implementation strategies to encourage a culture change required to adopt the MET system. Methods: A critical review the relevant literature of studies focussed on the MET system. Results: The majority of published work relating to MET systems was conducted in single‐centres. The introduction of MET systems appears to be linked to a reported reduction in adverse outcomes and early recognition and intervention in clinically deteriorating patients. Additionally, a consistent observation in the studies reviewed was the reported presence of clinically abnormal physiological observations prior to the clinical events such as the cardiac arrest. The evidence in support of MET or equivalent systems, is not straightforward. Issues such as education, resources (human and financial) and communication are vital to success with implementation. Responding promptly to patients who unexpectedly become acutely ill demands skill and competence; however, more research evaluating the role of early ’response’ systems is warranted.     

Y.O.O. Rock Columbia County: Development of a Volunteer Reference Guide for Families,Children, and Youth

TOPIC: Y.O.O. Rock Columbia County Youth Outreach Opportunities for Families Children, and Youth ( Waibel‐Duncan & Gillam, 2009 ) represents our nonurban county's first organized effort to systematically identify and promote awareness of volunteer and outreach opportunities for families, children, and youth. PURPOSE: In addition to describing Y.O.O. Rock's development, this article summarizes feedback from parents, professionals, and paraprofessionals and outlines their recommendations for the second edition of the guide. SOURCE: Issue briefs from the Corporation for National & Community Service (2005, 2006, 2008 ) suggest the need for reference guides like Y.O.O. Rock insofar as they document limited volunteer and outreach opportunities for young children as well as the family's role in engaging children in service to others. CONCLUSION: This article will inform others who seek to increase families', children's, and youth's awareness of volunteer activities and outreach opportunities in their communities.     

Critical care outreach 1: an exploration of fundamental philosophy and underpinning knowledge

Critical care outreach (Outreach) is central to the effective management of critically ill patients. Its recent, expedited and somewhat uncoordinated introduction has, however, resulted in a lack of understanding about the fundamental philosophical theories and sources of knowledge that underpin it. Furthermore, there is a lack of understanding of the context in which these are applied. It is important that we understand and are able to provide sound rationale and guidance for current and future Outreach practice, for the education of practitioners and in order to evaluate and show the impact of Outreach on patient care. The need for this is heightened in the context of current changes in roles and role boundaries, in which there are significant pressures and expectations from organizations for Outreach teams to demonstrate their effectiveness. The authors argue that the complex situations encountered and managed by Outreach are not amenable to traditional forms of measurement and that its impact on patient care is, therefore, not readily acknowledged by those external to the service. This study explores the philosophical underpinnings and types of knowledge inherent in the practice of Outreach. In doing so, it illuminates how they apply and contribute to the practice and impact of Outreach.     

An outreach program improved osteoporosis management after a fracture

This longitudinal retrospective cohort study evaluated implementation of an intervention to improve management of osteoporosis after a fracture in a nonprofit group-model health maintenance organization (HMO) in the U.S. Pacific Northwest with 480,000 members and electronic medical record data. Participants were female HMO members aged 67 and older who sustained a qualifying clinical fracture(s) and who had not received a bone mineral density (BMD) measurement or osteoporosis treatment in the 12 months before the fracture (N=3,588). Phase 1 included outreach to clinicians and patients; Phase 2 added clinician and staff incentives. Primary outcome was "osteoporosis management"--receipt of a BMD measurement or osteoporosis medication in the 6 months after an index fracture. Before the intervention, 13.4% (95% confidence interval (CI)=12.0-14.8%) of patients had received osteoporosis management, and the time trend was not significant. Post-intervention, the probability of osteoporosis management increased on average 3.1% (95% CI=2.6-3.5%) every 2 months throughout both study phases without a significant added improvement in Phase 2. Improvement varied according to clinic and was less likely for patients with dementia. Overall, the probability of osteoporosis management increased from the baseline level of 13.4% to 44.0% (95% CI=40.0-48.0%) by the end of the study period (20 months post-intervention). The study found that an outreach program to primary care providers and patients improved the management of osteoporosis after a fracture. If widely implemented, this intervention could substantially improve the secondary prevention of osteoporosis. More-individualized interventions may be necessary for high-risk subgroups.     

Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions

Middleton JW, McCormick M, Engel S, Rutkowski SB, Cameron ID, Harradine P, Johnson JL, Andrews D. Issues and challenges for development of a sustainable service model for people with spinal cord injury living in rural regions.

Objective

To develop and implement a service model for people with spinal cord injury (SCI) living in rural regions.

Design

Service development, pilot evaluation study.

Setting

Regional and remote areas of the state of New South Wales, Australia.

Participants

Persons with SCI, caregivers, and health professionals.

Intervention

Phase 1 included initial needs analysis, followed by education and resource development tailored to needs of rural health professionals, caregivers, and persons with SCI. Phase 2 included coordination, professional support, and network development by part-time rural key worker and metropolitan-based project officer, documenting health- and service-related issues.

Main Outcome Measures

Self-perception of confidence as a result of education as well as reported issues, adverse health events, and barriers to service provision.

Results

Clinician confidence in managing people with SCI improved after education. Various health-related, environmental, and psychosocial issues were reported. Limited availability of resources and health infrastructure, particularly in more isolated or smaller towns, challenged service provision. Rural key workers played a central role in supporting local clinicians and service providers, improving communication and service coordination between rural health professionals and metropolitan SCI services.

Conclusion

Education and support for rural workforce that may be limited in numbers and capacity, and a model facilitating communication and coordination between services, are essential for improving health outcomes of rural people with SCI.     

Impact of pharmacy outreach services on blood pressure management in the elderly community of Hong Kong

Aim: To investigate the impact of the Pharmacy Outreach Service (POS) on blood pressure (BP) and disease knowledge among community‐dwelling elderly patients with hypertension, and to evaluate the sustainability of such impact of POS. Methods: A prospective open‐labeled study of elderly adults (aged ≥65 years) with hypertension (BP ≥140/90 mmHg for non‐diabetics and ≥130/80 mmHg for diabetics) was carried out at seven elderly community centers from July 2008 to March 2010. Pharmacists provided BP monitoring, medication review and disease knowledge assessment. The target BP was <140/90 mmHg for non‐diabetics and <130/80 mmHg for diabetics. The primary outcome was BP change, whereas the secondary outcome was the change of disease knowledge of hypertension. All outcomes were compared between baseline and the last visit. For POS 2008/09 participants, BP was compared between values obtained during POS 2008/09 and 2009/10. Results: A total of 97 participants were recruited. Systolic BP reduced significantly from 152.38 ± 18.80 mmHg to 147.04 ± 20.72 mmHg (P = 0.021), and diastolic BP reduced from 73.84 ± 11.36 mmHg to 71.03 ± 10.97 mmHg (P = 0.010). Cumulative reductions in mean systolic BP and diastolic BP throughout the 2‐year study period were 21.39 ± 24.72 mmHg and 9.88 ± 13.48 mmHg, respectively (P < 0.001). A 12% increase in the at‐goal rate was observed in new participants recruited in 2009 (P = 0.039). Disease knowledge of hypertension improved significantly (P < 0.005), particularly in areas that included the definition of hypertension, diet and lifestyle modification. Conclusions: The POS might improve blood pressure control, hypertension and diabetes knowledge in elderly adults with hypertension in Hong Kong. The effect on blood pressure improvement was sustainable. Geriatr Gerontol Int 2013; 13: 175–181.     

Assertive Outreach: An Effective Strategy for Engaging Homeless Persons with Substance Use Disorders into Treatment

The purpose of this study was to examine substance abuse treatment referrals that were made by outreach workers in a homeless outreach project. Ten outreach workers completed questionnaires on each of their clients who they had referred to a substance abuse treatment program over the previous year. Additional data was collected on the client's motivation level at the point the referral was made, which agencies the client was referred to, and if the client was rejected from any of the treatment programs. Bivariate correlation analyses were used to examine relationships between the variables. Of 73 project clients who were referred to substance abuse treatment in a one-year period of time, 41% successfully entered treatment. As might be expected, there was a statistically significant relationship between clients' motivation level and completed referral, and between referrals made and program acceptance. This study provides evidence that assertive outreach is effective in engaging and linking homeless persons with substance use disorders to substance abuse treatment services.