Systems-Based Practice/InvestigationCharacteristics and outcomes of patients receiving a medical emergency team review for respiratory distress or hypotension☆,☆☆
Introduction
Studies conducted both in Australia [1] and the United States [2] suggest that serious adverse events contribute to almost 400 000 deaths per year [3]. These events are preceded by signs of instability in up to 80% of cases [4], [5]. The medical emergency team (MET) system was introduced to treat hospital patients who are identified to be at risk for having an adverse event [6]. Most studies of the MET have focused on its possible role and effectiveness in reducing unplanned intensive care unit (ICU) admissions, cardiac arrests, or deaths. Less information exists on the “trigger” for MET review, its underlying condition, and its relationship to outcome. Moreover, no information exists on the effect of delayed MET activation and subsequent patient outcome.
A recent study classified MET calls into a number of MET syndromes based on the derangement of vital signs leading to its activation [7]. The term syndrome was used because these patients have a cluster of clinical features such as hospital admission, location outside a critical care area, short-term derangement of vital signs for one or more vital organ systems, and sufficient acuity to justify a decision by a nurse or physician to activate an emergency response. Among these syndromes, respiratory distress and hypotension were particularly common [7]. However, no information was provided on the characteristics, final diagnosis, outcome, and timeliness of MET activation for these patients. We hypothesized that a delay in MET activation might increase the risk of adverse outcomes. Accordingly, we conducted a retrospective study to describe the characteristics, underlying clinical diagnosis, and hospital outcomes of patients receiving a MET review exclusively for respiratory distress or exclusively for hypotension and to study the incidence and duration of delayed MET activation and its relationship with patient outcome.
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Ethics approval
The hospital human research ethics committee approved the study. As the study involved collection of de-identified patient information, the need for informed consent was waived by the hospital human research ethics committee.
Setting
The Austin Hospital (Victoria, Australia) is a teaching hospital affiliated to the University of Melbourne (Victoria, Australia). The Austin Hospital campus (400 beds) receives all short-term admissions of this area. The acute care campus admits approximately 60 000
Baseline patient characteristics
The median patient age was similar in both groups (Table 1). Patients requiring review for the MET syndrome of respiratory distress (MET-RD) syndrome were more likely to have had surgery but less likely to have a history of congestive cardiac failure compared to patients with the MET syndrome of hypotension (MET-HT). Severe sepsis was present in 58% of cases, and 9% of patients were NFR before the MET call.
Patient outcomes
The hospital mortality for patients with MET-RD and MET-HT was 38% and 35%, respectively.
Discussion
We conducted a retrospective study of 200 patients receiving a MET review for the MET syndromes of isolated respiratory distress and isolated hypotension. We found that patients requiring MET calls for these 2 syndromes were elderly and typically had many comorbidities, that sepsis was a common finding, and that hospital mortality was more than 35%. We also found that delayed MET activation was more common and the delay longer for patients with respiratory distress. Furthermore, we found that,
Acknowledgments
We would like to thank the medical emergency team and intensive care unit staff for their enthusiasm and commitment to patient care.
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Cited by (0)
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Supported by the Austin Hospital Intensive Care Trust Fund (Victoria, Australia).
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The authors declare that there is no conflict of interest in relation to this study.