Cretikos M, Hillman K. The medical emergency team: Does it really make a difference? Internal Medicine Journal. 2003;33(11):511-514.

Review. Lists benefits of a medical emergency team and discusses how it empowers nursing staff and junior medical staff to call for immediate assistance.

Cooper N. Patient at risk! Clinical Medicine. 2001;1(4):309-311.

This article summarizes recent efforts in the U.K. to improve care for critically ill patients.  Among the activities described is the development of early warning scoring systems to be used on general medical wards to identify patients who might benefit from transfer to an ICU.

Cioffi J. Recognition of patients who require emergency assistance: A descriptive study. Heart and Lung. 2000;29(4):262-268.

Primary findings showed that nurses relied on the following four characteristics to apply the medical emergency team criterion, “seriously worried about a patient”: feeling “not right,” color, agitation, observations marginally changed or not changed at all.  Additional validation and refinement of the four characteristics were recommended. 

Castle N, Kenward G, Hodgetts T. Avoidable cardiac arrest: Lessons for an A&E department. Accident and Emergency Nursing. 2003;11(4):196-201.

Deterioration to cardiac arrest is not always sudden and unexpected and, as a vast majority of emergency admissions originate via A&E, this has implications for A&E. 

Buist M, Bernard S, Nguyen TV, Moore G, Anderson J. Association between clinically abnormal observations and subsequent in-hospital mortality: A prospective study. Resuscitation. 2004;62(2):137-141.

Six abnormal clinical observations were found to be independently associated with an increased high risk of mortality: decrease in level of consciousness (decrease > 2 points in Glasgow Coma Score)(odds ratio (OR) 6.4), hypotension (systolic blood pressure < 90 mmHg)(OR 2.5), loss of consciousness (Glasgow Coma Score of 3)(OR 6.4), respiratory rate < 6/min (OR 14.4), hypoxia (SaO₂ < 90 percent)(OR 2.4), and tachypnea (respiratory rate > 30/min)(OR 7.2).  Among these events, the most common were hypoxia (51 percent of events) and hypotension (17 percent).

Buist M, Bernard S, Anderson J. Epidemiology and prevention of unexpected in-hospital deaths. The Surgeon. 2003;1(5):265-268.

Small literature review. Concluded that a number of studies suggest that in-hospital deaths are both predictable and preventable and that more work is required to determine effective strategies to manage the problem. 

Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: Preliminary study. British Medical Journal. 2002;324(7334):387-390.

Clinical intervention by a medical emergency team prompted by clinical instability in a patient significantly reduced the incidence of unexpected cardiac arrest (50 percent reduction after adjustment for case mix) and mortality from unexpected cardiac arrest.  

Buist MD, Jarmolowski E, Burton PR, Bernard SA, Waxman BP, Anderson J. Recognising clinical instability in hospital patients before cardiac arrest or unplanned admission to intensive care. A pilot study in a tertiary-care hospital. Medical Journal of Australia. 1999;171(1):22-25.

Over a 12-month period relatively few patients suffered a critical event, but those who did frequently manifested abnormalities in simple physical observations and laboratory tests prior to the critical event. 

Bristow PJ, Hillman KM, Chey T, et al. Rates of in-hospital arrests, deaths and intensive care admission: The effect of a medical emergency team. Medical Journal of Australia. 2000;173(5):236-240.

Three hospitals were included, one with a medical emergency team (MET) which could be called for abnormal physiological parameters or staff concern, while the other two had conventional cardiac arrest teams. There was no significant difference in the rates of cardiac arrest or total deaths among the three hospitals, but the MET hospital had fewer unanticipated ICU/HD admissions, with no increase in in-hospital arrest rate or total death rate.

Berlot G, Pangher A, Petrucci L, Bussani R, Lucangelo U. Anticipating events of in-hospital cardiac arrest. European Journal of Emergency Medicine. 2004;11(1):24-28.

Most in-hospital cardiac arrests were preceded by events (including alterations in consciousness, cardiac arrhythmias, dyspnoea, and chest pain) that were often overlooked.