Triggers for emergency team activation: a multicenter assessment

Jack Chen, Rinaldo Bellomo, Ken Hillman, Arthas Flabouris, Simon Finfer, MERIT Study Investigators for the Simpson Centre and the ANZICS Clinical Trials Group

Research output: Contribution to journalArticlepeer-review

37 Citations (Scopus)


Purpose: The purpose of the study was to examine triggers for emergency team activation in hospitals with or without a medical emergency team (MET) system. 

Materials and methods: 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. 

Results: 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. 

Conclusions: 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.

Original languageEnglish
Pages (from-to)359.e1-359.e7
Number of pages7
JournalJournal of Critical Care
Issue number2
Publication statusPublished - Jun 2010
Externally publishedYes


  • Attitude of Health Personnel
  • Emergency Service, Hospital/organization & administration
  • Glasgow Coma Scale
  • Heart Rate
  • Hospital Rapid Response Team/statistics & numerical data
  • Hospitals/classification
  • Humans
  • Respiratory Rate
  • Workforce


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