***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Abstract Objectives : To determine whether earlier clinical intervention by a medical emergency team prompted by clinical instability in a patient could reduce the incidence of and mortality from unexpected cardiac arrest in hospital . Design : A non-r and omised , population based study before ( 1996 ) and after ( 1999 ) introduction of the medical emergency team . Setting : 300 bed tertiary referral teaching hospital . Participants : All patients admitted to the hospital in 1996 ( n=19 317 ) and 1999 ( n=22 847 ) . Interventions : Medical emergency team ( two doctors and one senior intensive care nurse ) attended clinical ly unstable patients immediately with resuscitation drugs , fluid , and equipment . Response activated by the bedside nurse or doctor according to predefined criteria . Main outcome measures : Incidence and outcome of unexpected cardiac arrest . Results : The incidence of unexpected cardiac arrest was 3.77 per 1000 hospital admissions ( 73 cases ) in 1996 ( before intervention ) and 2.05 per 1000 admissions ( 47 cases ) in 1999 ( after intervention ) , with mortality being 77 % ( 56 patients ) and 55 % ( 26 patients ) , respectively . After adjustment for case mix the intervention was associated with a 50 % reduction in the incidence of unexpected cardiac arrest ( odds ratio 0.50 , 95 % confidence interval 0.35 to 0.73 ) . Conclusions : In clinical ly unstable in patients early intervention by a medical emergency team significantly reduces the incidence of and mortality from unexpected cardiac arrest in hospital . What is already known on this topic In most studies mortality from unexpected cardiac arrest in hospital exceeds 50 % Such events are usually preceded by signs of clinical deterioration in the hours before cardiac arrest What this paper adds Early intervention by a medical emergency team significantly reduced the incidence of and mortality from unexpected cardiac arrest in BACKGROUND Patients with cardiac arrests or who die in general wards have often received delayed or inadequate care . We investigated whether the medical emergency team ( MET ) system could reduce the incidence of cardiac arrests , unplanned admissions to intensive care units ( ICU ) , and deaths . METHODS We r and omised 23 hospitals in Australia to continue functioning as usual ( n=11 ) or to introduce a MET system ( n=12 ) . The primary outcome was the composite of cardiac arrest , unexpected death , or unplanned ICU admission during the 6-month study period after MET activation . Analysis was by intention to treat . FINDINGS Introduction of the MET increased the overall calling incidence for an emergency team ( 3.1 vs 8.7 per 1000 admissions , p=0.0001 ) . The MET was called to 30 % of patients who fulfilled the calling criteria and who were subsequently admitted to the ICU . During the study , we recorded similar incidence of the composite primary outcome in the control and MET hospitals ( 5.86 vs 5.31 per 1000 admissions , p=0.640 ) , as well as of the individual secondary outcomes ( cardiac arrests , 1.64 vs 1.31 , p=0.736 ; unplanned ICU admissions , 4.68 vs 4.19 , p=0.599 ; and unexpected deaths , 1.18 vs 1.06 , p=0.752 ) . A reduction in the rate of cardiac arrests ( p=0.003 ) and unexpected deaths ( p=0.01 ) was seen from baseline to the study period for both groups combined . INTERPRETATION The MET system greatly increases emergency team calling , but does not substantially affect the incidence of cardiac arrest , unplanned ICU admissions , or unexpected death Objective To determine whether the introduction of an intensive care unit-based medical emergency team , responding to hospital-wide preset criteria of physiologic instability , would decrease the rate of predefined adverse outcomes in patients having major surgery . Design Prospect i ve , controlled before- and -after trial . Setting University-affiliated hospital . Patients Consecutive patients admitted to hospital for major surgery during a 4-month control phase and during a 4-month intervention phase . Interventions Introduction of a hospital-wide intensive care unit-based medical emergency team to evaluate and treat in- patients deemed at risk of developing an adverse outcome by nursing , paramedical , and /or medical staff . Measurements and Main Results We measured incidence of serious adverse events , mortality after major surgery , and mean duration of hospital stay . There were 1,369 operations in 1,116 patients during the control period and 1,313 in 1,067 patients during the medical emergency team intervention period . In the control period , there were 336 adverse outcomes in 190 patients ( 301 outcomes /1,000 surgical admissions ) , which decreased to 136 in 105 patients ( 127 outcomes /1,000 surgical admissions ) during the intervention period ( relative risk reduction , 57.8 % ; p < .0001 ) . These changes were due to significant decreases in the number of cases of respiratory failure ( relative risk reduction , 79.1 % ; p < .0001 ) , stroke ( relative risk reduction , 78.2 % ; p = .0026 ) , severe sepsis ( relative risk reduction , 74.3 % ; p = .0044 ) , and acute renal failure requiring renal replacement therapy ( relative risk reduction , 88.5 % ; p < .0001 ) . Emergency intensive care unit admissions were also reduced ( relative risk reduction , 44.4 % ; p = .001 ) . The introduction of the medical emergency team was also associated with a significant decrease in the number of postoperative deaths ( relative risk reduction , 36.6 % ; p = .0178 ) . Duration of hospital stay after major surgery decreased from a mean of 23.8 days to 19.8 days ( p = .0092 ) . Conclusions The introduction of an intensive care unit-based medical emergency team in a teaching hospital was associated with a reduced incidence of postoperative adverse outcomes , postoperative mortality rate , and mean duration of hospital stay INTRODUCTION  Atrial fibrillation ( AF ) in hospitalized patients may lead to activation of the medical emergency team ( MET ) . We sought to assess the baseline characteristics and outcomes of the patients presenting AF as a cause of MET call activation . METHODS Using a prospect ively constructed MET data base , we retrospectively review ed all patients with AF as a trigger for MET activation between August 2005 and April 2010 . Demographics , principal diagnostic and outcome of these patients were compared with those of a control group of patients matched for age , sex and ward of origin , r and omly selected from the data base . RESULTS We studied 5431 MET calls of which 557 ( 10.3 % ) , in 458 patients were triggered by AF . Mean age for AF patients was 74.8 years , 230 ( 50.2 % ) were female and 271 ( 59.1 % ) were in a surgical ward . 92 ( 20.1 % ) AF patients died in hospital compared with 131 ( 28.6 % ) in the control group . Among the 336 patients without limitations of medical therapy ( LOMT ) , 46 ( 13.7 % ) died in hospital . In total , 46 ( 13.7 % ) patients were transferred to a higher level care ward while 290 ( 86.3 % ) remained on the ward . Only 2 ( 4.3 % ) of these patients died compared with 44 ( 15.2 % ) among those who remained in the general ward ( p=0.03 ) . CONCLUSIONS In our hospital , AF triggers one tenth of MET activations and mortality associated with it is high even when issues of LOMT are excluded . The decreased mortality among patients admitted to a higher level ward suggests that some of these deaths may be avoidable OBJECTIVE To examine NFR orders in relation to adverse events and emergency team calls in hospitals with or without a Medical Emergency Team ( MET ) system during the MERIT study . METHOD Within a cluster r and omized controlled trial ( the MERIT study ) , examining the effect of introducing a MET system , we recorded NFR orders in relation to adverse events and emergency team calls . We compared the proportion and rate of  NFR  orders issued in relation to " adverse events " and " adverse event-free emergency team calls " in hospitals with or without a MET system . RESULTS Information on NFR orders was available for 3650 patients who died , 1466 patients who had an unplanned ICU admission , 574 patients who suffered a cardiac arrest and 1529 patients who had a adverse event-free emergency team call . Close to 90 % of deaths occurred in patients with a previously documented NFR order . Only approximately 4 % of cardiac arrests had a previously documented NFR order . In patients with unplanned ICU admission , NFR orders were present in approximately 3 % of cases . An NFR order was issued at the time of an " event " in 3.85 % of cases in MET hospitals compared with 1.72 % in control hospitals ( OR=2.29 ; 95 % CI : 1.31 - 4.01 ; p=0.005 ) . This difference was mostly due to a greater proportion of patients being made NFR in MET hospitals at the time of a " adverse event-free " emergency team call ( 7.96 % vs. 3.05 % ; OR=2.75 ; 95 % CI : 0.97 - 7.80 ; p=0.048 ) . The number of NFR orders issued at the time of a serious adverse event-free emergency team call was 10 times higher in MET hospitals ( 0.398 vs. 0.041 per 1000 admissions ; weighted absolute risk difference : 0.49 ( 95 % CI : 0.20 - 0.78 ; p=0.002 ) . Multivariate models could only account for less than 50 % of the variance in the issuing of NFR orders . CONCLUSIONS In a cohort of Australian hospitals , most deaths occurred in patients with a previously documented NFR order but NFR orders were uncommon before cardiac arrest calls or unplanned ICU admissions . During the conduct of a cluster r and omised controlled trial , more  NFR orders were issued by emergency teams in those hospitals that implemented a MET system than in control hospitals . MET allocation , teaching hospital status , number of hospital beds and metropolitan location could only explain less than 50 % of variance in NFR orders CONTEXT Rapid response teams have been shown in adult in patients to decrease cardiopulmonary arrest ( code ) rates outside of the intensive care unit ( ICU ) . Because a primary action of rapid response teams is to transfer patients to the ICU , their ability to reduce hospital-wide code rates and mortality remains unknown . OBJECTIVE To determine rates of hospital-wide codes and mortality before and after implementation of a long-term rapid response team intervention . DESIGN , SETTING , AND PATIENTS A prospect i ve cohort design of adult in patients admitted between January 1 , 2004 , and August 31 , 2007 , at Saint Luke 's Hospital , a 404-bed tertiary care academic hospital in Kansas City , Missouri .  Rapid response team education and program rollout occurred from September 1 to December 31 , 2005 . A total of 24 193 patient admissions were evaluated prior to the intervention ( January 1 , 2004 , to August 31 , 2005 ) , and 24 978 admissions were evaluated after the intervention ( January 1 , 2006 , to August 31 , 2007 ) . INTERVENTION Using st and ard activation criteria , a 3-member rapid response team composed of experienced ICU staff and a respiratory therapist performed the evaluation , treatment , and triage of in patients with evidence of acute physiological decline . MAIN OUTCOME MEASURES Hospital-wide code rates and mortality , adjusted for preintervention trends . RESULTS There were a total of 376 rapid response team activations . After rapid response team implementation , mean hospital-wide code rates decreased from 11.2 to 7.5 per 1000 admissions . This was not associated with a reduction in the primary end point of hospital-wide code rates ( adjusted odds ratio [ AOR ] , 0.76 [ 95 % confidence interval { CI } , 0.57 - 1.01 ] ; P = .06 ) , although lower rates of non-ICU codes were observed ( non-ICU AOR , 0.59 [ 95 % CI , 0.40 - 0.89 ] vs ICU AOR , 0.95 [ 95 % CI , 0.64 - 1.43 ] ; P = .03 for interaction ) . Similarly , hospital-wide mortality did not differ between the preintervention and postintervention periods ( 3.22 vs 3.09 per 100 admissions ; AOR , 0.95 [ 95 % CI , 0.81 - 1.11 ] ; P = .52 ) . Secondary analyses revealed few instances of rapid response team undertreatment or underuse that may have affected the mortality findings . CONCLUSION In this large single-institution study , rapid response team implementation was not associated with reductions in hospital-wide code rates or mortality Problem : Advance cardiac life support ( ACLS ) training does not address coordination of team re sources to improve the ability of teams to deliver needed treatments reliably and rapidly . Our objective was to use a human simulation training educational environment to develop multidisciplinary team skills and improve medical emergency team ( MET ) performance . We report findings of a crisis team training course that is focused on organization . Setting : Lar 
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Discussion s regarding LOMT were frequently performed more commonly than resuscitation interventions such as endotracheal intubation .