A physician-led medical emergency team increases the rate of medical interventions: A multicenter study in Korea

Abstract

Background According to the rapid response system’s team composition, responding teams were named as rapid response team (RRT), medical emergency team (MET), and critical care outreach. A RRT is often a nurse-led team, whereas a MET is a physician-led team that mainly plays the role of an efferent limb. As few multicenter studies have focused on physician-led METs, we comprehensively analyzed cases for which physician-led METs were activated. Methods We retrospectively analyzed cases for which METs were activated. The study population consisted of subjects over 18 years of age who were admitted in the general ward from January 2016 to December 2017 in 9 tertiary teaching hospitals in Korea. The data on subjects’ characteristics, activation causes, activation methods, performed interventions, in-hospital mortality, and intensive care unit (ICU) transfer after MET activation were collected and analyzed. Results In this study, 12,767 cases were analyzed, excluding those without in-hospital mortality data. The subjects’ median age was 67 years, and 70.4% of them were admitted to the medical department. The most common cause of MET activation was respiratory distress (35.1%), followed by shock (11.8%), and the most common underlying disease was solid cancer (39%). In 7,561 subjects (59.2%), the MET was activated using the screening system. The commonly performed procedures were arterial line insertion (17.9%), intubation (13.3%), and portable ultrasonography (13.0%). Subsequently, 29.4% of the subjects were transferred to the ICU, and 27.2% died during hospitalization. Conclusions This physician-led MET cohort showed relatively high rates of intervention, including arterial line insertion and portable ultrasonography, and low ICU transfer rates. We presume that MET detects deteriorating patients earlier using a screening system and begins ICU-level management at the patient’s bedside without delay, eventually preventing the patient’s condition from worsening and transfer to the ICU.

The effect of a dedicated intensivist staffing to a medical emergency team on airway management in general wards

“…The emergency airway management is one of the major critical care interventions performed by METs. [ 1 , 2 , 4 , 5 ] Its importance cannot be overemphasized because it is closely related to serious consequences and high morbidity and mortality in failed cases. [ 6 , 7 ] Therefore, many efforts have been made to improve the quality of emergency airway management.…”

Where to now with Rapid Response Systems?

“…Many different models of Critical Care outreach and rapid response have been tried and shown success. Some are entirely nurse-led (Massey et al 2015;Pirret, 2008;Williams et al 2022a) some are nurse-led with medical backup (Aitken et al, 2015;So et al, 2019), others are medically led with nurse back up (Lee et al 2021) and some truly multidisciplinary (Al-Omari et al, 2019).…”