Elsevier

Resuscitation

Volume 49, Issue 2, May 2001, Pages 135-141
Resuscitation

The evolutionary process of Medical Emergency Team (MET) implementation: reduction in unanticipated ICU transfers

https://doi.org/10.1016/S0300-9572(00)00353-1Get rights and content

Abstract

Objectives: To determine whether the introduction of the Medical Emergency Team (MET) system designed to provide immediate help for seriously ill patients: (i) changed the pattern of ICU patient transfers from the wards; and (ii) improved hospital survival rates. Methods: Prospective information on MET calls and unanticipated ICU transfers was collected for 3 years in a suburban metropolitan hospital. Results: A 3-year review of MET showed the number of MET calls doubled in the second and third year and the team was activated for more than just the most extremely ill patients. Whilst the frequency of calls for cardiopulmonary arrest remained constant (n=16), increased use of the MET resulted in the proportion of calls for cardiopulmonary arrest dropping from 30% in year 1 to 13% in year 3. A slight decrease in the percentage of in-hospital deaths (0.74% in year 1 to 0.65% in year 3) was also demonstrated. The incidence of cardiopulmonary arrest per hospital admission also decreased slightly (0.08–0.07%). Although the overall number of ICU transfers remained constant, more seriously ill patients were transferred to ICU via the MET system. This was accompanied by a significant fall in unanticipated ICU transfers. Whilst the reduction in hospital deaths was encouraging, this study could not demonstrate whether the slight improvement in hospital survival rate over the 3 years was due to the MET system. Conclusion: More information is needed to demonstrate that the MET system improves patient survival. The study also highlights the importance of taking proactive measures, which should include providing in-service education on the benefits of early identification and treatment of patients who are at risk of acute deterioration, raising awareness and changing attitudes in hospitals when introducing system such as the MET.

Zusammenfassung

Para determinar se a introdução de uma equipa de emergência médica (EEM), destinada a fornecer ajuda imediata a doentes extremamente graves, (i) mudou o padrão de transferência de doentes das enfermarias para cuidados intensivos, e (ii) se melhorou a taxa de sobrevivência hospitalar. Métodos: Foi recolhida, ao longo de 3 anos, informação prospectiva das chamadas da EEM e das transferências não antecipadas para cuidados intensivos, num hospital metropolitano periférico. Resultados: Uma revisão de 3 anos de EEM mostrou que o número de chamadas duplicou no segundo e no terceiro ano e que a equipa foi activada para mais do que doentes extremamente graves. Enquanto que a frequência de chamadas por paragem cardı́aca permaneceu constante (n=16) o aumento da utilização da EEM resultou numa queda da percentagem de chamadas por paragem de 30% no primeiro ano para 13% no terceiro ano. Também foi demonstrada uma ligeira diminuição na percentagem de mortes intra-hospitalar (0.74% no primeiro ano para 0.65% no terceiro ano). A incidência de paragem cardio-pulmonar por admissão hospitalar também diminuiu ligeiramente (0.08–0.07%). Apesar do número global das transferências para cuidados intensivos ter permanecido constante, os doentes mais graves foram transferidos para cuidados intensivos através do sistema de EEM. Isto foi acompanhado de uma queda significativa nas transferências não programadas. Apesar da redução no numero de mortes ser encorajadora, não foi possı́vel demonstrar por este estudo se a ligeira melhoria na taxa de sobrevivência hospitalar foi devida ao sistema de EEM. Conclusão: E necessária mais informação para demonstrar que o sistema de EEM melhora a sobrevivência. Este estudo também sublinha a importância de tomar medidas pró-activas que deveriam incluir formação dentro dos serviços sobre os benefı́cios da identificação e do tratamento precoce dos doentes em risco de deterioração aguda, aumentando a atenção para estes e mudando atitudes no hospital aquando da introdução de um sistema de EEM.

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

References (20)

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