BMJ Qual Saf 20:115-120 doi:10.1136/bmjqs.2008.029876
  • Original research

The impact of the medical emergency team on the resuscitation practice of critical care nurses

  1. Clinical Analysis Group
  1. 1CNC, MET, The Simpson Centre for Health Services Research, Liverpool Hospital, Sydney, Australia
  2. 2The Simpson Centre for Health Services Research, Liverpool Hospital, Sydney, Australia
  3. 3Quality Assurance Resource CNC, The Simpson Centre for Health Services Research, Liverpool Hospital, Sydney, Australia
  4. 4Centre for Language in Social Life, Macquarie University, North Ryde, Australia
  5. 5Department of Linguistics, Macquarie University, North Ryde, Australia
  6. 6Intensive Care Unit, University of New South Wales, Liverpool Hospital, Sydney, Australia
  1. Correspondence to Nancy Santiano, Simpson Centre for Health Services Research, Liverpool Health Service, Locked Bag 7103, Liverpool BC NSW 1871, Australia; Nancy.Santiano{at}
  • Accepted 27 August 2009
  • Published Online First 6 January 2011


Background Medical Emergency Teams (MET)/rapid response are replacing Cardiac Arrest teams in acute hospitals. There is a lack of knowledge about how Critical Care Nurses (CCNs), rostered on MET construct their responsibilities/roles.

Objective Assess MET nurse activities at different hospitals.

Methods The authors used visual ethnography; selecting Systemic Functional Grammar as our methodological framework. The Generic Systemic Potential was used to guide the coding of visual and inferential meaning of the activities of MET nurses. CCNs coded over 6 h of videoed MET calls, sampled across three hospitals, Sydney, Australia.

Results The first layer of coding contained 1042 discreet tasks. They were sorted into 15 Areas of Practice (AOPs) and then allocated to aspects of performance (psychomotor and cognitive). The AOPs ‘Assisting with Procedure’ through to ‘Monitoring Vital Signs’ reflect psychomotor skills which account for almost half (48%) of the AOPs at site 1 and three-quarters at sites 2 (70%) and 3 (78%). Eight generic responsibilities/roles were identified. ‘Ongoing Assessment,’ ‘Re-evaluating Risk’ and ‘Prioritising Interventions’ were the most prominent. The patterns differed by hospital: ‘Re-evaluating Risk’ was prominent for sites 1 and 2 but less so for site 3.

Conclusion ‘Ongoing Assessment’ and ‘Re-evaluating Risk’ occupied almost half of the MET nurses time, whereas ‘Establishing Patient Acuity, the key activity in CA teams, occupied only 4%. These findings provide evidence of the roles of CCNs in the MET and suggest that education and training of MET nurses should support these roles.


  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Sydney South West Area Health Services—Ethics & Research Office, Liverpool.

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

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