Intended for healthcare professionals

Practice Quality Improvement Report

Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital

BMJ 2007; 335 doi: (Published 06 December 2007) Cite this as: BMJ 2007;335:1210
  1. Michael Buist, intensive care director 1,
  2. Julia Harrison, staff specialist1,
  3. Ellie Abaloz, nurse unit manager 1,
  4. Susan Van Dyke, quality manager
  1. 1Intensive Care Unit, Dandenong Hospital, PO Box 478, Dandenong, VIC 3175, Australia
  1. Correspondence to: M Buist mbuist{at}
  • Accepted 10 October 2007


Problem In-hospital cardiac arrest often represents failure of optimal clinical care. The use of medical emergency teams to prevent such events is controversial. In-hospital cardiac arrests have been reduced in several single centre historical control studies, but the only randomised prospective study showed no such benefit. In our hospital an important problem was failure to call the medical emergency team or cardiac arrest team when, before in-hospital cardiac arrest, patients had fulfilled the criteria for calling the team.

Design Single centre, prospective audit of cardiac arrests and data on use of the medical emergency team during 2000 to 2005.

Setting 400 bed general outer suburban metropolitan teaching hospital.

Strategies for change Three initiatives in the hospital to improve use of the medical emergency team: orientation programme for first year doctors, professional development course for medical registrars, and the evolving role of liaison intensive care unit nurses.

Key measures for improvement Incidence of cardiac arrests.

Effects of the change Incidence of cardiac arrests decreased 24% per year, from 2.4/1000 admissions in 2000 to 0.66/1000 admissions in 2005.

Lessons learnt Medical emergency teams can be efficacious when supported with a multidisciplinary, multifaceted education system for clinical staff.


  • Contributors: MB has overseen the implementation and development of the medical emergency team, the intern orientation programme, and components of the registrar professional development programme and prepared the manuscript. JH wrote and designed the registrar professional development course. EA developed the nurse liaison programme. SVD designed, developed, and maintained the audit system and database. All authors have contributed to this manuscript and have approved the final version.MB is guarantor.

  • Funding: No additional funding.

  • Competing interests: None declared.

  • Ethical approval: Not required

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 10 October 2007
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