Characteristics and outcomes of patients receiving review requests for pre-medical emergency team deterioration: a cohort study

Abstract

Objective. The aim of this study was to describe the epidemiology of pre-medical emergency team (pre-MET) reviews, including patient characteristics, the frequency and nature of triggers and interventions and in-hospital outcomes.Methods. An exploratory retrospective cohort study was performed using a medical record audit. Fifty orthopaedic and general medicine patients at a hospital in Melbourne, Australia, with requests for pre-MET reviews in 2016 were included. Descriptive analyses were performed.Results. The median patient age was 80 years (interquartile range 19 years). Most patients were female (64%), general medical patients (82%), with limitation of medical treatment orders (52%) and modified pre-MET triggers (42%). Documented pre-MET reviews occurred for 68% of requests. Tachypnoea (24%) and staff worry (24%) were the most common pre-MET triggers. One-third of patients received two clinical interventions. One in five patients had repeat requests for a pre-MET review within 12 h. In-hospital mortality was 12%.Conclusions. Most requests for pre-MET reviews related to older female patients. Clinician adherence to pre-MET policy was variable. Multicentre studies are needed to inform improvements to pre-MET strategies.What is known about the topic? Australian hospitals have introduced multi-tiered rapid response systems (RRSs) that consist of pre-MET review to comply with accreditation standards. Pre-MET reviews are triggered by early signs of clinical deterioration and are provided by admitting medical teams or senior nurses. There is limited understanding of the characteristics and outcomes of patients receiving pre-MET reviews for early clinical deterioration. What does this paper add? In a cohort of orthopaedic and general medicine patients, most patients receiving requests for pre-MET reviews were older, female medical patients, with existing modifications to pre-MET triggers. Most requests for pre-MET review were for tachypnoea or staff worry; the latter included clinical problems not addressed by predefined organisational triggers. One in five patients continued to deteriorate within 12 h of the pre-MET request. Clinician adherence to pre-MET policy varied.

Rapid Response Team Activation Triggers in Adults and Children: An Integrative Review

“…Many studies have evaluated in-hospital mortality after RRT implementation, with estimates ranging from 8% to 15% (Currey et al, 2022; Lyons et al, 2019; Shoaib et al, 2021; Smith et al, 2017). Gong et al (2020) reported that RRT implementation reduced overall in-hospital mortality by 40%; however, two studies (Considine et al, 2017; Padilla & Mayo, 2019) highlighted that delayed RRT activation were strongly associated with a higher rate of in-hospital mortality.…”

“…Respiratory, cardiovascular, and neurological were the three most frequently cited symptom categories for RRT activation (Table 4). Ten studies identified respiratory symptoms, specifically tachypnea at >25 breaths per minute and oxygen saturation at <90%, as the top triggers for RRT activation (Byrne et al, 2021; Churpek et al, 2017; Considine et al, 2017; Currey et al, 2022; Fernando et al, 2019; Lyons et al, 2019; Sebat et al, 2020; Shappell et al, 2018; Tirkkonen et al, 2017; Viana et al, 2021). The RRT was also activated for new-onset breathing difficulty, bradypnea, acute respiratory distress, chronic respiratory disease, and complex respiratory failure (Byrne et al, 2021; Fernando et al, 2019; Lyons et al, 2019; Na et al, 2020; Orosz et al, 2020; Shappell et al, 2018; Smith et al, 2017; Tirkkonen et al, 2017; Viana et al, 2021).…”

“…Cardiovascular was the second most common activation category, with six studies identifying these issues as the top concern for RRT activation (Kim et al, 2021; Na et al, 2020; Padilla & Mayo, 2019; Sebat et al, 2020; Shoaib et al, 2021; Smith et al, 2017). Among all the studies included in this review, heart rate at >130 beats per minute and hemodynamic instability required RRT calls (Byrne et al, 2021; Chalwin et al, 2019; Considine et al, 2017; Currey et al, 2022; Fernando et al, 2019; Kim et al, 2021; Lyons et al, 2019; Na et al, 2020; Shappell et al, 2018; Shoaib et al, 2021; Smith et al, 2017). Arrhythmias were less frequently reported (Viana et al, 2021).…”

“…Conflicting findings regarding LOS after RRT activation were found. Currey et al (2022) found that after an initial RRT activation, the median LOS decreased from 9 to 5 days, whereas Fernando et al (2019) reported an increase from 12 to 21 days. Delay in RRT activation for more than 1 hour can increase LOS to 32.4 days compared with 19.9 days for RRT activation without delay (Padilla & Mayo, 2019).…”

“…Rapid response teams—also known as medical emergency teams , and critical care outreach teams —are multidisciplinary health teams that include nurses, physicians, pharmacists, and respiratory therapists. These teams aim to provide early recognition and treatment of patients’ clinical deterioration to avoid unfavorable outcomes (Currey et al, 2022; Kolovos et al, 2018). The ideal utilization rate of the RRT in adult and pediatric settings has been reported to be 40 calls per 1000 admissions (Lyons et al, 2018).…”