***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    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 A ‘ patient‐at‐risk team ’ , established to allow the early identification of seriously ill patients on hospital wards , made 69 assessment s on 63 patients over 6 months . Predefined physiological criteria were not able to reliably predict which patients would be admitted to the intensive care unit . The incidence of cardiopulmonary resuscitation before intensive care admission was 3.6 % for patients seen by the team and 30.4 % for those not seen ( p < 0.005 ) . Of admissions seen by the team , 25 % died on the intensive care unit compared with 45 % of those not seen ( not significant , p = 0.07 ) . Among those not seen by the team , mortality was 40 % for those who did not require resuscitation and 57 % for those who did ( not significant ) . Many critically ill ward patients had abnormal physiological values before intensive care unit admission . Identification of critically ill patients on the ward and early advice and active management are likely to prevent the need for cardiopulmonary resuscitation and to improve outcome The effects of introducing Modified Early Warning scores to identify medical patients at risk of catastrophic deterioration have not been examined . We prospect ively studied 1695 acute medical admissions . All patients were scored in the admissions unit . Patients with a Modified Early Warning score > 4 were referred for urgent medical and critical care outreach team review . Data was compared with an observational study performed in the same unit during the proceeding year . There was no change in mortality of patients with low , intermediate or high Modified Early Warning scores . Rates of cardio‐pulmonary arrest , intensive care unit or high dependency unit admission were similar . Data analysis confirmed respiratory rate as the best discriminator in identifying high‐risk patient groups . The therapeutic interventions performed in response to abnormal scores were not assessed . We are convinced that the Modified Early Warning score is a suitable scoring tool to identify patients at risk . However , outcomes in medical emergency admissions are influenced by a multitude of factors and so it may be difficult to demonstrate the score 's benefit without further st and ardizing the response to abnormal values Abstract Objective . To document the characteristics and incidence of serious abnormalities in patients prior to admission to intensive care units . Design and setting . Prospect i ve follow-up study of all patients admitted to intensive care in three acute-care hospitals . Patients . The study population totalled 551 patients admitted to intensive care : 90 from the general ward , 239 from operating rooms ( OR ) and 222 from the Emergency Department ( ED ) . Measurements and results . Patients from the general wards had greater severity of illness ( APACHE II median 21 ) than those from the OR ( 15 ) or ED ( 19 ) . A greater percentage of patients from the general wards ( 47.6 % ) died than from OR ( 19.3 % ) and ED ( 31.5 % ) . Patients from the general wards had a greater number of serious antecedents before admission to intensive care 43 ( 72 % ) than those from OR 150 ( 64.4 % ) or ED 126 ( 61.8 % ) . Of the 551 patients 62 had antecedents during the period 8–48 h before admission to intensive care , and 53 had antecedents both within 8 and 48 h before their admission . The most common antecedents during the 8 h before admission were hypotension ( n=199 ) , tachycardia ( n=73 ) , tachypnoea ( n=64 ) , and sudden change in level of consciousness ( n=42 ) . Concern was expressed in the clinical notes by attending staff in 70 % of patients admitted from the general wards . Conclusions . In over 60 % of patients admitted to intensive care potentially life-threatening abnormalities were documented during the 8 h before their admission . This may represent a patient population who could benefit from improved resuscitation and care at an earlier stage The Early Warning Score ( EWS ) is a simple physiological scoring system suitable for bedside application . The ability of a modified Early Warning Score ( MEWS ) to identify medical patients at risk of catastrophic deterioration in a busy clinical area was investigated . In a prospect i ve cohort study , we applied MEWS to patients admitted to the 56-bed acute Medical Admissions Unit ( MAU ) of a District General Hospital ( DGH ) . Data on 709 medical emergency admissions were collected during March 2000 . Main outcome measures were death , intensive care unit ( ICU ) admission , high dependency unit ( HDU ) admission , cardiac arrest , survival and hospital discharge at 60 days . Scores of 5 or more were associated with increased risk of death ( OR 5.4 , 95%CI 2.8 - 10.7 ) , ICU admission ( OR 10.9 , 95%CI 2.2 - 55.6 ) and HDU admission ( OR 3.3 , 95%CI 1.2 - 9.2 ) . MEWS can be applied easily in a DGH medical admission unit , and identifies patients at risk of deterioration who require increased levels of care in the HDU or ICU . A clinical pathway could be created , using nurse practitioners and /or critical care physicians , to respond to high scores and intervene with appropriate changes in clinical management Introduction Introducing an intensive care unit (ICU)-based medical emergency team ( MET ) into our hospital was associated with decreased postoperative in-hospital mortality after major surgery . The purpose of the present study was to assess the effect of the MET and other variables on long-term mortality in this patient population . Methods We conducted a prospect i ve , controlled , before- and -after trial in a University-affiliated hospital . Participants included consecutive patients admitted for major surgery ( surgery requiring hospital stay > 48 hours ) during a four month control phase and a four month MET phase . The intervention involved the introduction of a hospital-wide ICU-based MET service to evaluate and treat ward patients with acutely deranged vital signs . Information on long-term mortality was obtained from the Australian death registry . The main outcome measure was patient mortality at 1500 days . Data on patient demographics , surgery undertaken and whether the surgery was scheduled or unscheduled was obtained from the hospital electronic data base . Multivariable analysis was conducted to determine independent predictors of 1500-day mortality . Results There were 1,369 major operations in 1,116 patients during the control period and 1,313 operations in 1,067 patients during the MET ( intervention ) period . Overall survival at 1500 days was 65.8 % in the control period and 71.6 % during the MET period ( P = 0.001 ) . Patients in the control phase were statistically less likely to be admitted under orthopaedic surgery , urology and faciomaxillary surgery units , but more likely to be admitted under cardiac surgery or neurosurgery units . Patients in the MET period were less likely to undergo unscheduled surgery . Multivariable analysis revealed that age , unscheduled surgery and admission under thoracic surgery , neurosurgery , oncology and general medicine were independent predictors of increased 1500-day mortality . Admission during the MET period was also an independent predictor of decreased 1500-day mortality ( odds ratio 0.74 ; P = 0.005 ) . Conclusion Introduction of a MET service in a teaching hospital was associated with increased long-term survival even after adjusting for other factors that contribute to long-term surgical mortality Introduction It is unknown whether the reported short-term reduction in cardiac arrests associated with the introduction of the medical emergency team ( MET ) system can be sustained . Method We conducted a prospect i ve , controlled before- and -after examination of the 
    Output:
    
The results of the two included studies showed either no evidence of the effectiveness of outreach  or a reduction in overall mortality in patients receiving outreach .