The evolutionary process of Medical Emergency Team (MET) implementation: reduction in unanticipated ICU transfers
Introduction
The high mortality rate and poor outcomes after in-hospital cardiac arrest are well known [1], [2], [3]. However, cardiac arrest is commonly preceded by premonitory signs and symptoms [4], [5], which, if acted upon early, might result in better outcomes [6]. The Medical Emergency Team (MET) concept subscribes to the hypothesis that early identification of the seriously ill will result in improved patient outcome [7], [8], [9], [10]. In essence, the MET system ‘takes intensive care expertise to the wards’ [8] where early intervention in seriously ill patients may prevent some intensive care unit (ICU) admissions, deaths and cardiac arrests [8]. The MET system might also help remedy the recently reported problem of suboptimal care in the general wards [11], which has been widely acknowledged and debated by physicians and experts in acute care [6], [12], [13].
The MET system of medical emergency intervention was introduced by Liverpool Hospital, NSW, Australia in 1990 [7], [14], to enable early identification and aggressive management of seriously ill patients before the advent of a cardiac arrest. In addition to a number of hospitals within the South West Sydney region, the MET system has also been adopted and reported in a hospital in Perth, WA [9]. A number of studies of the MET concept have examined the use of the MET [7], [14] as well as nurses knowledge and use of the system [15], [16].
The MET system is based on standardised calling criteria that encompass a broader response to medical emergencies than the Cardiac Arrest Team system. These standardised calling criteria (Appendix A) identify key pathological and physiological abnormalities and indicate acute deterioration of the patient [14]. Any staff member may activate the MET via the established emergency paging system at any time using the predetermined calling criteria, if they become concerned about the patient's condition.
The main aims of this study were to examine the effects of the MET system on admission to ICU and on hospital mortality rate over a 3-year period.
Section snippets
Setting
Campbelltown Hospital is a 200-bed non-teaching hospital in the South West Sydney region of NSW, Australia. The MET system was introduced in July 1996. The hospital has a busy emergency department and an eight bed intensive care/coronary care unit. The 24 h MET system consists of one physician and one nursing staff member from the intensive care/coronary care unit, a medical registrar from the emergency department, and two other non-clinical staff. The intensive care registrar is skilled in
Data analysis
Data was coded and entered into SPSS for Windows version 7.5 [17]. Descriptive analyses statistics were used to summarise the sample characteristics: percentages for discrete variables and mean and standard deviation for continuous variables. χ2 tests were used to compare categorical data. The level of statistical significance for analyses was set at P<0.05. All significance tests were two-tailed.
Results
Between July 1996 and June 1999, 299 calls were made to the Medical Emergency Team. In the first year, calls averaged one per week and had risen to two per week by the second year (Table 1). Of these calls, 88% were from hospital wards, 9% from Emergency and ICU/CCU departments, and 3% from the Operating Theatres. The mean age was 60.5 years (range: 0–97 years). The gender mix was approximately equal (51% female and 49% male). Seventy-one percent of patients survived to hospital discharge.
The
Discussion
This 3-year review of the MET system showed a more than twofold increase in the number of MET calls during the second and third year. This was a result of the MET system being called increasingly for less acute patients. The evidence for this is the reduction in the proportion of MET calls for cardiopulmonary arrest, and the proportion of MET call patients transferred to intensive care, together with the fall in hospital mortality of patients for whom the MET system was activated. Only 13% of
Acknowledgements
We wish to acknowledge Julie Kesby-Smith, the former Nurse Unit Manager of ICU/CCU department, without whom the implementation of the MET concept in Campbelltown Hospital in 1996 would not have been possible. We thank the Intensive Care Staff for completing the MET forms and Clinical Information staff for assisting in clinical record retrievals. We also wish to extend our sincere thanks to Malcolm Masso, Director Nursing and Acute Services for his support and encouragement and Professor Ken
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