Marjon Borgert

54 Chapter 3 bene t of one emergency team being operational is that there is no uncertainty about which team to call. However, several disadvantages have been described as well. For instance, barriers exist to call a large attending team for clinically deteriorating patients who might not be seriously ill, but for whom the team must be called according to the prede ned calling criteria. 35 Moreover, inexperienced sta s sometimes feel anxious about seeking help and calling this team. 35 This also results in patients receiving delayed care. Limitations The present study has some limitations. We analysed the CAT activations for FAs retrospectively. The data was, however, real-time registered in the database. Another limitation is that the data is from a single medical centre and the results may not be generalizable to other hospitals. Another limitation is that in our hospital two emergency teams are operational. The composition and call procedures of emergency teams varies highly between hospitals, which has consequences for the generalisability of our results. By excluding the out-patient department, emergency rooms and public areas in the data-analysis, the total number of patients with FAs for whom the CAT was activated might be an underestimation of the results. Finally, analysis of the RRT calls was not possible due to lack of a prede ned system of classifying RRT calls in the hospital. Future research Future research is needed in order to nd e ective strategies for implementing the MEWS on nursing wards and to improve the sustainable adoption of the MEWS. Computerised decision support could play a role especially as we are moving towards systems in which all vital signs are monitored continuously by using a wireless patient monitoring system. 36 Use of qualitative research methods are needed to provide data on why and how the implementation succeeded or not as well as to explore nurses’ perceptions and experiences of using the MEWS and related protocols. 37 Using a qualitative approach would allow exploration around measuring the MEWS, barriers to activate the emergency teams or to identify external environment factors, such as busyness of wards. Furthermore, research should focus on how emergency teams could be optimised by either merging or rearranging the composition of both teams to achieve both nancial and qualitative bene ts.