***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 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 OBJECTIVES : This is the first large multicenter study to examine the effectiveness of a pediatric rapid response system ( PRRS ) . The primary objective was to determine the effect of a PRRS using a physician-led team on the rate of actual cardiopulmonary arrests , defined as an event requiring chest compressions , epinephrine , or positive pressure ventilation . The secondary objectives were to determine the effect of PRRSs on the rate of PICU readmission within 48 hours of discharge and PICU mortality after readmission and urgent PICU admission . METHODS : A PRRS was developed , implemented , and evaluated in a st and ardized manner across 4 pediatric academic centers in Ontario , Canada . The team responded to activations for in patients and followed patients discharged from the PICU for 48 hours . A 2-year , prospect i ve , observational study was conducted after implementation , and outcomes were compared with data collected 2 years before implementation . RESULTS : After PRRS implementation , there were 55 963 hospital admissions and a team activation rate of 44 per 1000 hospital admissions . There were 7302 patients followed after PICU discharge . Implementation of the PRRS was not associated with a reduction in the rate of actual cardiopulmonary arrests ( 1.9 vs 1.8 per 1000 hospital admissions ; P = .68 ) or PICU mortality after urgent admission ( 1.3 vs 1.1 per 1000 hospital admissions ; P = .25 ) . There was a reduction in the PICU mortality rate after readmission ( 0.3 vs 0.1 death per 1000 hospital admissions ; P = .05 ) . CONCLUSION : The st and ardized implementation of a multicenter PRRS was associated with a decrease in the rate of PICU mortality after readmission but not actual cardiopulmonary arrests PURPOSE The purpose of the study was to determine whether earlier clinical intervention by a medical emergency team ( MET ) can improve patient outcomes in an Asian country . METHODS A nonr and omized study was performed during two 6-month periods before and after the introduction of a MET . RESULTS The rates of cardiac arrests and " potentially preventable " cardiac arrests were lower after MET introduction , but the differences did not reach statistical significance . There was a statistically significant decrease in the incidence of cardiac arrests in the first 3 months of the academic year ( 2.3 vs 1.2 per 1000 admissions , P = .012 ) . Introduction of MET reduced the time interval from physiologic derangement meeting MET activation criteria to intensive care unit ( ICU ) admission ( " derangement-to-ICU interval " ) ( 10.8 vs 6.3 hours , P < .001 ) . Multivariate analysis revealed that the mortality of unplanned ICU admissions was independently associated with simplified acute physiology score 3 and " derangement-to-ICU interval . " CONCLUSIONS Introduction of a MET reduced the number of cardiac arrests in the general ward during the first 3 months of the academic year . Introduction of MET also decreased the " derangement-to-ICU interval , " which was an independent predictor of survival in patients with unplanned ICU admissions . Therefore , MET introduction may lead to improved outcomes for hospitalized patients in a country with limited medical re sources INTRODUCTION Although rapid response systems ( RRS ) have been shown to decrease the incidence of cardiac arrest ( CA ) , there are no studies evaluating optimal staffing . We hypothesize that there are no outcome differences between ICU physician and senior resident led events . METHODS A retrospective study of the RRS data base at a single , academic hospital was performed from July 1 , 2006 to May 31 , 2010 . Surgical patients and those in the ICU were excluded . Daytime ( D ) was defined as 7 am-5 pm Monday through Friday , and weekends were defined as 5 pm on Friday to 6:59 am on Monday . The nurse to patient ratio is constant during all shifts . An ICU physician leads daytime events on weekdays whereas night/weekend ( NW ) events are led by residents . NW events were compared against D events using chi square or Fischer 's exact test . Significance was defined as p<0.05 . RESULTS A total of 1404 events were review ed with 534 ( 38 % ) D and 870 ( 62 % ) NW events . Respiratory and staff concerns were more likely during NW compared to D ( 50 % vs. 39 % and 46 % vs. 34 % , p<0.001 , respectively ) . Following RRS activation , no difference was noted between D and NW periods in the incidence of progression to CA , transfer to ICU , or hospital mortality . Invasive procedures were more common in the NW period . CONCLUSION Resident-led RRS may have similar outcomes to attending intensivist led events . Prospect i ve studies are needed to determine the ideal team composition 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 
    Output:
    
Conclusion Rapid response systems were associated with a reduction in hospital mortality and cardiopulmonary arrest .
Meta-regression did not identify the presence of a physician in the rapid response system to be significantly associated with a mortality reduction