***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of 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 Objective To explore the causes of failure to activate the rapid response system ( RRS ) . The organisation has a recognised incidence of staff failing to act when confronted with a deteriorating patient and leading to adverse outcomes . Design A multi- method study using the following : a point prevalence survey to determine the incidence of abnormal simple bedside observations and activation of the rapid response team by clinical staff ; a prospect i ve audit of all patients experiencing a cardiac arrest , unplanned intensive care unit admission or death over an 8-week period ; structured interviews of staff to explore cognitive and sociocultural barriers to activating the RRS . Setting Southern Health is a comprehensive healthcare network with 570 adult in-patient beds across four metropolitan teaching hospitals in the south-eastern sector of Melbourne . Measurements Frequency of physiological instability and outcomes within the in-patient hospital population . Qualitative data from staff interviews were thematically coded . Results The incidence of physiological instability in the acute adult population was 4.04 % . Nearly half of these patients ( 42 % ) did not receive an appropriate clinical response from the staff , despite most ( 69.2 % ) recognising their patient met physiological criteria for activating the RRS , and being ‘ quite ’ , or ‘ very ’ concerned about their patient ( 75.8 % ) . Structured interviews with 91 staff members identified predominantly sociocultural reasons for failure to activate the RRS . Conclusions Despite an organisational commitment to the RRS , clinical staff act on local cultural rules within the clinical environment that are usually not explicit . Better underst and ing of these informal rules may lead to more appropriate activation of the RRS 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 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 AIMS AND OBJECTIVES To evaluate the relationship between  nurse demographics  and correct identification of clinical situations warranting specific nursing actions , including activation of the medical emergency team . BACKGROUND If abnormal physiology is left untreated , the patient may develop cardiac arrest . Nurses in general wards are those who perceive any clinical deterioration in patients . DESIGN A descriptive , quantitative design was selected . METHODS An anonymous survey with 13 multiple choice questions was distributed to 150 r and omly selected nurses working in general medical and surgical wards of a large tertiary hospital in Athens , Greece . After explanation of the purpose s of the study , 94 nurses ( response ratio : 62 % ) agreed to respond to the question naire . RESULTS Categories with the greatest nursing concern were patients with heart rate<40/minute , an atypical thoracic pain , foreign body airway obstruction and bronchial secretions , respiratory rate<5/minute and heart rate=100/minute . However , almost 50 % of nurses were able to accurately identify the critical nursing action for patients with respiratory rate<4/minute , 72 % for patients with airway obstruction and 73 % for patients with chest pain . Nurses who had graduated from a four-year educational programme identified clinical situations that necessitated medical emergency team activation in a significantly higher rate and also scored significantly higher in questions concerning clinical evaluation than nurses who had graduated from a two-year educational programme . CONCLUSION Activation of the medical emergency team is influenced by factors such as level of education and cardiopulmonary resuscitation courses attendance . RELEVANCE TO CLINICAL PRACTICE Graduating from a four-year educational programme helps nurses identify emergencies . However , irrespective of the educational programme they have followed , undertaking a basic life support or advanced life support provider course is critical as it helps them identify cardiac or respiratory emergencies Objective : To examine the relationship between early emergency team calls and the incidence of serious adverse events — cardiac arrests , deaths , and unplanned admissions to an intensive care unit — in a cluster r and omized controlled trial of medical emergency team implementation ( the MERIT study ) . Design : Post hoc analysis of data from cluster r and omized controlled trial . Setting and Participants : Twenty-three public hospitals in Australia and 741,744 patients admitted during the conduct of the study . Interventions : Attendance by a rapid response system team or cardiac arrest team . Main Outcome Measures : The relationship between the proportion of rapid response system team calls that were early emergency team calls ( defined as calls not associated with cardiac arrest or death ) and the rate ( events/1000 admissions ) of the adverse events . Results : We analyzed 11,242 serious adverse events and 3700 emergency team calls . For every 10 % of increase in the proportion of early emergency team calls there was a 2.0 reduction per 10,000 admissions in unexpected cardiac arrests ( 95 % confidence interval [ CI ] −2.6 to −1.4 ) , a 2.2 reduction in overall cardiac arrests ( 95 % CI −2.9 to −1.6 ) , and a 0.94 reduction in unexpected deaths ( 95 % CI −1.4 to −0.5 ) . We found no 
    Output:
    
Inconsistent RRS activation has been associated with negative patient outcomes .
Exploring nurses ' perceived barriers to RRS activation may contribute to interventions that lead to nurses appropriately activating the RRS and potentially decreasing adverse patient outcomes