• Henry T Stelfox, Sean M Bagshaw, and Song Gao.
• 1Departments of Critical Care Medicine, Medicine, and Community Health Sciences, Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB, Canada. 2Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada. 3Alberta Health Services, Edmonton, AB, Canada.
• Crit. Care Med.. 2014 Jul 1;42(7):1601-9.

ObjectiveTo describe the occurrence of recurrent clinical deterioration and repeat medical emergency team activation and assess its effect on processes and outcomes of care.DesignRetrospective cohort study.SettingTwo community hospitals and two tertiary care hospitals, Alberta, Canada.PatientsConsecutive hospitalized adult patients with sudden clinical deterioration and medical emergency team activation without admission to ICU.InterventionNone.Measurement And Main ResultsWe compared ICU admission rates (admissions > 2 hr following index medical emergency team), hospital length of stay, and hospital mortality for a cohort of 3,200 patients with and without recurrent clinical deterioration following medical emergency team activation adjusting for patient, provider, and hospital characteristics.The cohort consisted of 3,200 patients. Ten percent of patients (n = 337) experienced recurrent clinical deterioration and repeat medical emergency team activation during their hospital stay. Patients more likely to experience recurrent clinical deterioration and repeat medical emergency team activation included those with chronic liver disease (odds ratio, 1.75; 95% CI, 1.14-2.69) or who received airway suctioning (odds ratio, 1.66; 95% CI, 1.23-2.25), noninvasive mechanical ventilation (odds ratio, 1.67; 95% CI, 0.94-2.94), or central IV catheter insertion (odds ratio, 1.81; 95% CI, 1.02-3.21) during the index medical emergency team activation. Patients with recurrent clinical deterioration were more likely than patients without recurrent clinical deterioration to be subsequently admitted to ICU (43% vs 13%; odds ratio, 6.11; 95% CI, 4.67-8.00; p < 0.01), to have longer lengths of hospital stay (median, 31 d vs 13 d; p < 0.01), and to die during their hospital stay (34% vs 23%; odds ratio, 1.98; 95% CI, 1.47-2.67; p < 0.01).ConclusionsRecurrent clinical deterioration and repeat medical emergency team activation are common and associated with increased risk of subsequent ICU admission, increased length of hospital stay, and increased hospital mortality. It may be possible to identify patients at risk of recurrent clinical deterioration following medical emergency team activation and target interventions to improve patient care.

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