RESUMEN
OBJECTIVE: Medical emergency teams (MET) are mostly led by physicians. Some hospitals are currently using nurse practitioners (NP) to lead MET calls. These are no studies comparing clinical outcomes between these two care models. To determine whether NP-led MET calls are associated with lower risk of acute patient deterioration, when compared to intensive care (ICU) registrar (ICUR)-led MET calls. METHODS: The composite primary outcome included recurrence of MET call, occurrence of code blue or ICU admission within 24 h. Secondary outcomes were mortality within 24 h of MET call, length of hospital stay, hospital mortality and proportion of patients discharged home. Propensity score matching was used to reduce selection bias from confounding factors between the ICUR and NP group. RESULTS: A total of 1343 MET calls were included (1070 NP, 273 ICUR led). On Univariable analysis, the incidence of the primary outcome was higher in ICUR-led MET calls (26.7% vs. 20.6%, p = 0.03). Of the secondary outcome measures, mortality within 24 h (3.4% vs. 7.7%, p = 0.002) and hospital mortality (12.7% vs. 20.5%, p = 0.001) were higher in ICUR-led MET calls. Propensity score-matched analysis of 263 pairs revealed the composite primary outcome was comparable between both groups, but NP-led group was associated with reduced risk of hospital mortality (OR 0.57, 95% CI 0.35-0.91, p = 0.02) and higher likelihood of discharge home (OR 1.55, 95% CI 1.09-2.2, p = 0.015). CONCLUSION: Acute patient deterioration was comparable between ICUR- and NP-led MET calls. NP-led MET calls were associated with lower hospital mortality and higher likelihood of discharge home.
Asunto(s)
Cuerpo Médico de Hospitales/normas , Enfermeras Practicantes/normas , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Grupo de Atención al Paciente/normas , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Cuerpo Médico de Hospitales/estadística & datos numéricos , Persona de Mediana Edad , Enfermeras Practicantes/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/métodos , Grupo de Atención al Paciente/estadística & datos numéricos , Puntaje de Propensión , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricosRESUMEN
Q fever is a zoonotic disease that is most commonly associated with outbreaks in slaughterhouses. We describe an outbreak of 4 cases occurring in a factory that processes ovine fetal products for the cosmetics industry. It is important that industries typically not associated with risk of Q fever are made aware of potential health risks that workers might be exposed to so further outbreaks might be prevented.
