Incidence of missed medical emergency team (MET) activation

Guinane, Jessica; Bucknall, Tracey; Currey, Judith; Jones, Daryl

doi:10.1016/j.aucc.2010.12.028

Cited by 4 publications

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“…This is an important area for consideration. Patients who have abnormal vital signs or RRS activation are at higher risk of poorer outcomes such as unplanned ICU admissions, longer hospital stays, and higher mortality (Churpek et al., 2013; Guinane et al., 2013; Hosking et al., 2014; Sprogis et al., 2017). Lack of resources such as equipment or high workloads may contribute to a lack of follow‐up monitoring ability (Petersen et al., 2017).…”

Section: Discussionmentioning

confidence: 99%

“…Since RRS evolution in the 1990s, literature has focused on patients who received a Medical Emergency Team (MET) call or who fulfilled MET criteria, finding higher in‐hospital mortality rates with low MET activation and an association with poorer patient outcomes (Bucknall, Jones, Bellomo, & Staples, 2013; Guinane, Bucknall, Currey, & Jones, 2013; Le Lagadec & Dwyer, 2017; Tirkkonen, Huhtala, & Hoppu, 2018). However, the clinical response to deterioration in patients varies worldwide, with a range of different tools and values to prompt escalation such as Modified Early Warning Scores or single‐parameter triggers.…”

Section: Introductionmentioning

confidence: 99%

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The pre‐Medical Emergency Team response: Nurses' decision‐making escalating deterioration to treating teams using urgent review criteria

Bingham

Fossum

Hughes

et al. 2020

Journal of Advanced Nursing

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Aim:To describe nurses' decision-making, experiences and perceptions of escalating deteriorating patients to the treating medical team using urgent clinical review criteria. Design:A qualitative design comprising individual in-depth interviews with nurses from a major Australian metropolitan tertiary teaching hospital. Method:A purposive sample of 30 Registered Nurses from nine surgical and medical wards were interviewed in April 2018 using semi-structured interviews. An inductive thematic analysis was conducted.Results: Identified themes included: detecting the deterioration; countering the problem; getting a response; and challenges faced in the process of escalation. Nurses reported an important awareness, sense of responsibility, and critical thinking to ensure the safe management and escalation of deteriorating patients. However, barriers to escalation necessitated individual workarounds and organizational structures to mitigate patient risk. Conclusion:This study supports the importance of communication between clinical teams and recognizes that it is crucial to enable a fail-safe experience for patients and families. Recognition of disciplinary contributions to patients' goals of care is required to better understand and address the prevalence of deteriorating patients. Our study is among the first to explore the actual experience of nurses who articulate balancing uncertainty and managing complex team dynamics on wards for patients experiencing deteriorating health status. The information may assist in determining team training strategies and structures to facilitate patient management during deterioration.Impact: This is among the first study to investigate barriers influencing decisionmaking of RNs prior to escalation using qualitative methods. This study provides a foundation to inform and develop policies and strategies aimed at ensuring escalation occurs for deteriorating patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The pre‐Medical Emergency Team response: Nurses' decision‐making escalating deterioration to treating teams using urgent review criteria

Bingham

Fossum

Hughes

et al. 2020

Journal of Advanced Nursing

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“…In our study, hyperthermia was associated with increased likelihood of escalation of care in both pre-MET and MET contexts and this may be due to long-standing initiatives such as the focus on early recognition and response to sepsis and improvements in processes of care for patients with sepsis. (Bingham et al, 2020;Donohue & Endacott, 2010;Guinane et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…There are numerous published studies of vital sign assessment by nurses (Brekke et al, 2019;Bucknall et al, 2022; and nurses' compliance with RRS activation in patients with vital sign abnormalities (Bingham et al, 2015;Bucknall et al, 2022;Bucknall, Jones, Bellomo, Staples, & for the RESCUE Investigators, 2013;Guinane et al, 2013;Shearer et al, 2012). One of the largest studies was the Prioritising Responses of Nurses To deteriorating patient Observations (PRONTO) pragmatic cluster…”

Section: Introductionmentioning

confidence: 99%

Vital sign assessment and nursing interventions in medical and surgical patients with rapid response system triggers

Considine

Hutchinson

Mitchell

et al. 2023

Journal of Clinical Nursing

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Aim(s)To explore vital sign assessment (both complete and incomplete sets of vital signs), and escalation of care per policy and nursing interventions in response to clinical deterioration.DesignThis cohort study is a secondary analysis of data from the Prioritising Responses of Nurses To deteriorating patient Observations cluster randomised controlled trial of a facilitation intervention on nurses' vital sign measurement and escalation of care for deteriorating patients.MethodsThe study was conducted in 36 wards at four metropolitan hospitals in Victoria, Australia. Medical records of all included patients from the study wards during three randomly selected 24‐h periods within the same week were audited at three time points: pre‐intervention (June 2016), and at 6 (December 2016) and 12 months (June 1017) post‐intervention. Descriptive statistics were used to summarise the study data, and relationships between variables were examined using chi‐square test.ResultsA total of 10,383 audits were conducted. At least one vital sign measurement was documented every 8 h in 91.6% of audits, and a complete set of vital signs was documented every 8 h in 83.1% of audits. There were pre‐Medical Emergency Team, Medical Emergency Team or Cardiac Arrest Team triggers in 25.8% of audits. When triggers were present, a rapid response system call occurred in 26.8% of audits. There were 1350 documented nursing interventions in audits with pre‐Medical Emergency Team (n = 2403) or Medical Emergency Team triggers (n = 273). One or more nursing interventions were documented in 29.5% of audits with pre‐Medical Emergency Team triggers and 63.7% of audits with Medical Emergency Team triggers.ConclusionWhen rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration.Relevance to Clinical PracticeMedical and surgical ward nurses in acute care wards frequently engage in vital sign assessment. Interventions by medical and nurgical nurses may occur prior to, or in parallel with calling the rapid response system. Nursing interventions are a key but under‐recognised element of the organisational response to deteriorating patients.Implications for the profession and/or patient careNurses engage in a range of nursing interventions to manage deteriorating patients, (aside from rapid response system activation) that are not well understood, nor well described in the literature to date.Impact This study addresses the gap in the literature regarding nurses' management of deteriorating patients within their scope of practice (aside from RRS activation) in real world settings. When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. The results of this research are relevant to nurses working on medical and surgical wards. Reporting MethodThe trial was reported according to the Consolidated Standards of Reporting Trials extension for Cluster Trials recommendations, and this paper is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement.Patient or Public ContributionNo Patient or Public Contribution.

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“…Furthermore, the presence of MET criteria was associated with a marked increase in-hospital, 30-and 60-day mortality (Bucknall et al, 2013). Similarly, in a retrospective observational study to determine the incidence of patients fulfilling MET criteria during their entire hospital admission, one in seven patients (14%) had vital signs that fulfilled one or more MET call criteria, yet MET activation was remarkably low (Guinane, Bucknall, Currey, & Jones, 2011).…”

Section: Introductionmentioning

confidence: 99%

Patient perceptions of deterioration and patient and family activated escalation systems—A qualitative study

Guinane

Hutchinson

Bucknall

2018

Journal of Clinical Nursing

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Incidence of missed medical emergency team (MET) activation

Cited by 4 publications

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The pre‐Medical Emergency Team response: Nurses' decision‐making escalating deterioration to treating teams using urgent review criteria

The pre‐Medical Emergency Team response: Nurses' decision‐making escalating deterioration to treating teams using urgent review criteria

Vital sign assessment and nursing interventions in medical and surgical patients with rapid response system triggers

Patient perceptions of deterioration and patient and family activated escalation systems—A qualitative study

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