Appendix 1. Dichotomized activation criteria used in TAYS.
Appendix 2. Template for core data recording on MET activations.
Appendix 3. Questionnaire to the hospitals (translated) Contact information of the respondent:
Hospital Name and title E-mail address Phone number
I. Background information 1. Hospital level:
1) University hospital
2) Satellite unit of a university hospital 3) Central hospital
4) District hospital 2.
1) Bed capacity of the hospital (n) 2) Admissions (n) / year
3. Does your hospital have any of the following intensive care units (ICUs)?
Please tick all that apply.
ICU type No Yes If yes, number of beds (n)
Mixed 0 1
Medical 0 1
Surgical 0 1
Cardiac 0 1
Pediatric 0 1
High dependency unit (HDU) 0 1
No ICU in the hospital 0
4. Does your hospital have monitored beds on general wards? Please tick all that apply.
Ward specialty No Yes If yes, number of beds (n)
Medical 0 1
Surgical 0 1
Neurology 0 1
Cardiac 0 1
Pediatric 0 1
No monitored beds in general wards 0
5. Presence of an anesthesiologist 1) Always
2) During office hours 3) Other hours, please explain 4) Never
II. Cardiac arrest teams
1. Does your hospital have a cardiac arrest team? If the answer is no, please go to chapter III.
1) Yes, operational 24/7
2) Yes, operational during office hours only
3) Yes, operational during other limited times, please specify 4) No
2. From which department does the cardiac arrest team operate?
1) Intensive care unit 2) Emergency department
3) Other department, please specify 3. Cardiac arrest team leader is 1) Anesthesiologist
2) Internal medicine physician 3) Surgeon
4) Nurse
5) Other health care professional, please specify
4. If the cardiac arrest team leader is a physician, is the team physician-led 1) 24/7
2) During office hours
3) During other limited times, please specify
5. Mechanical equipment of the cardiac arrest team. Please, tick all that apply.
1) Automated external defibrillator (AED) 2) Manual defibrillator
3) Backboard
4) CPR measurement and feedback device (e.g. Philips MRx QCPR®, CPRMeter®, Zoll Real CPR Help®)
5) Load-distributing band (e.g. AutoPulse®) 6) Other equipment, please record all
6. Does your hospital have an appointed person responsible for resuscitation training?
1) Yes, a physician 2) Yes, a nurse 3) No
7. Are data on cardiac arrest team activations documented to a specialized form?
1) Yes 2) No
8. Are these forms archived?
1) Yes 2) No
9. Are statistics compiled using the collected data?
1) Yes, according to the Utstein recommendations 2) Yes
3) No
10. If statistics have been compiled, how many cardiac arrests occurred (please, answer to all sections if possible)
1) In 2011 (n) 2) In 2010 (n)
3) During the last six months (n)
11. Is structured debriefing organized after resuscitation events?
1) Yes
2) No
III. Do not attempt resuscitation (DNAR) decisions
1. Do you have uniform guidelines on DNAR orders in your hospital?
1) Yes 2) No
3) I don’t know
2. Do you have uniform style to document DNAR orders in patient records??
1) Yes,
1. A combination of characters (e.g. DNAR) 2. A symbol
3. Other, please specify 2) No
3. Healthcare professionals who can make the decision to terminate unsuccessful resuscitation attempts and resuscitation attempts regarded as futile. Please tick all that apply.
No Yes
Ward nurse 0 1
Ward physician 0 1
Cardiac arrest team nurse 0 1
Cardiac arrest team physician 0 1
No one 0 1
IV. Medical emergency teams
1. Are you aware, that most in-hospital cardiac arrests are preceded by vital dysfunctions?
1) Yes 2) No
2. Does your hospital have a dedicated response team reacting for patient deterioration in general wards? (e.g.”Medical Emergency Team” (MET), “Rapid Response Team (RTT)”, “Critical Care Outreach Team” (CCOT)).If the answer is no, please go to chapter V.
1) Yes 2) No
3. When did the response team become operational? (e.g.1/2009) 4. From which department does this team operate?
1) Intensive care unit 2) Emergency department 3) Other, please specify
5. Is this team the same team as hospitals cardiac arrest team?
1) Yes
2) No, but it operates from the same department 3) No, and it operates from a different department 6. Does this dedicated medical emergency team operate 1) 24/7
2) During office hours only
3) During other limited times, please specify
7. Please tick below all team members and their numbers
No Yes Number
Anesthesiologist 0 1
Internal medicine physician 0 1
Surgeon 0 1
Intensive care unit nurse 0 1
Nurse of a different specialty 0 1
Other health care professional (please specify)
8. The team physician is
1) Always attending (consultant) 2) Always resident (senior house officer) 3) Attending or resident
4) Team has no physician
9. Do all team members react immediately in case of team activation?
1) Yes
2 No, depending on the case nurses may go in advance. However, physician will always participate at some point.
3) No, depending on the case nurses may go in advance. Physician participates if assessed appropriate.
4) Yes, because team as no physician.
10. Operational areas of hospitals medical emergency team. Please tick all that apply.
No Yes
Medical wards 0 1
Surgical wards 0 1
Monitored areas of medical wards 0 1
Monitored areas of surgical wards 0 1
Intensive care units 0 1
Pediatric wards 0 1
Operating room and post anaesthetic care unit 0 1
Emergency department 0 1
Diagnostic areas (laboratory etc.) 0 1
Public areas of the hospital 0 1
11. Individuals that are able to activate medical emergency team. Please tick all that apply.
No Yes
Physicians 0 1
Nurses 0 1
Other staff members 0 1
Patients 0 1
Visitors/Non-patients 0 1
12. Has education regarding vital dysfunctions and medical emergency team been organized to general ward staff?
1) Yes, all staff members have been educated 2) Yes, part of the staff members has been educated 3) No
13. Do predefined calling criteria for MET exist?
1) Yes 2) No
14. Medical emergency team calling criteria in your hospital. Please tick all that apply. Please also record activation thresholds where appropriate.
No Yes Thresholds
Cardiac arrest 0 1
Respiratory arrest 0 1
Respiratory rate 0 1 <
/min
>
/min
Spo2 0 1 < %
Systolic blood pressure 0 1 <
/mmHg
>
/mmHg
Heart rate 0 1 <
/min
>
/min
AVPU/ACDU-score 0 1 below 4 3 2 1 Glascow Coma Scale 0 1 score< / score change ___
units
‘Staff worried’ 0 1
Early Warning Score
(If yes, please provide a copy of used EWS)
0 1
15. Is medical emergency team able to implement treatment limitations?
1) Yes, independently
2) Yes, but only after consulting ward physician 3) No
16. Interventions that medical emergency team can implement independently.
Please tick all that apply.
No Yes
Intravenous fluids 0 1
Supplementary oxygen therapy 0 1
Intravenous vasoactive infusions (e.g. noradrenaline) 0 1
Arterial blood gas sample 0 1
Analysing arterial blood gas sample 0 1
Invasive (intra-arterial) blood pressure (IBP) monitoring 0 1
Defibrillation 0 1
CPAP –treatment 0 1
Intubation 0 1
17. Is a special form for note keeping used during team activations?
1) Yes 2) No
18. Are these forms archived?
1) Yes 2) No
19. Are statistics compiled using the collected data?
1) Yes 2) No
20. If statistics have been compiled, how many medical emergency team activations (including cardiac arrests) occurred (please, answer to all sections if possible)
1) in 2011 (n) 2) in 2010 (n)
3) during the last six months (n)
21. Have you received additional funding for MET implementation?
1) Yes 2) No
22. Structured training days per year for MET members (average)? (n)
23. In your opinion, have the following areas of in-hospital emergency medicine improved in your hospital during the last five years?
No Yes
Resuscitation 0 1
Prevention of in-hospital cardiac arrests 0 1
DNAR –decision policies 0 1
V. Critical care outreach: follow-up of discharged ICU patients
1. If assessed appropriate, follow-up visits to discharged ICU patients can be initiated.
If your answer is no, we thank you for your co-operation.
1) Yes 2) No
2. Follow-up visits are initiated for 1) All discharged ICU patients
2) All patients that fulfill the used selection criteria. Please tick all that apply.
No Yes
Prolonged ICU stay 0 1
Discharged to monitoredarea 0 1
Other, please specify Other, please specify Other, please specify
3) No criteria. Follow-up initiated when assessed appropriate by ICU physician 4. How many follow-up visits per day?
1) Always (n)
2) Depending on the case from (n) to (n)
5. The results of the conducted visit are reported to ICU physician 1) Always
2) If assessed appropriate