• Daryl A Jones, Sean M Bagshaw, Jonathon Barrett, Rinaldo Bellomo, Gaurav Bhatia, Tracey K Bucknall, Andrew J Casamento, Graeme J Duke, Noel Gibney, Graeme K Hart, Ken M Hillman, Gabriella Jäderling, Ambica Parmar, and Michael J Parr.
• Division of Critical Care Medicine, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada. Daryl.Jones@austin.org.au
• Crit. Care Med.. 2012 Jan 1;40(1):98-103.

ObjectiveTo investigate the role of medical emergency teams in end-of-life care planning.DesignOne month prospective audit of medical emergency team calls.SettingSeven university-affiliated hospitals in Australia, Canada, and Sweden.PatientsFive hundred eighteen patients who received a medical emergency team call over 1 month.InterventionsNone.Measurements And Main ResultsThere 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).ConclusionsIssues 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.

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