Medical Emergency Team: How do we play when we stay? Characterization of MET actions at the scene

Abstract

BackgroundThe creation, implementation and effectiveness of a medical emergency team (MET) in every hospital is encourage and supported by international bodies of quality certification. Issues such as what is the best composition of the team or the interventions performed by the MET at the scene and the immediate outcomes of the patients after MET intervention have not yet been sufficiently explored. The purpose of the study is to characterize MET actions at the scene and the immediate patient outcome.MethodsRetrospective cohort study, at a tertiary care, university-affiliated, 600-bed hospital, in the north of Portugal, over two years.ResultsThere were 511 MET activations: 389 (76 %) were for inpatients. MET activation rate was 8.6/1,000 inpatients. The main criteria for activation were airway threatening in 143 (36.8 %), concern of medical staff in 121 (31.1 %) and decrease in GCS > 2 in 98 (25.2 %) patients; MET calls for cardiac arrest occurred in 68 patients (17.5 %). The median (IQR) time the team stayed at the scene was 35 (20–50) minutes. At the scene, the most frequent actions were related to airway and ventilation, namely oxygen administration in 145 (37.3 %); in circulation, fluid were administered in 158 (40.6 %); overall medication was administered in 185 (47.5 %) patients. End-of-life decisions were part of the MET actions in 94 (24.1 %) patients. At the end of MET intervention, 73 (18.7 %) patients died at the scene, 190 (60.7 %) stayed on the ward and the remaining 123 patients were transferred to an increased level of care. Crude hospital mortality rate was 4.1 % in the 3 years previously to MET implementation and 3.6 % in the following 3 years (p < 0.001).DiscussionDuring the study period, the rate of activation for medical inpatients was significantly higher than that for surgical inpatients. In our hospital, there is no 24/7 medical cover on the wards, with the exception of high-dependency and intensive care units; assuming that the number of unplanned admissions and chronic ill patients is greater in medical wards that could explain the difference found, which prompts the implementation of a 24/7 ward residence.The team stayed on site for half an hour and during that time most of the actions were simple and nurse-driven, but in one third of all activations medical actions were taken, and in a forth (24%) end-of-life decisions made, reinforcing the inclusion of a doctor in the MET. A significant decrease in overall hospital mortality rate was observed after the implementation of the MET.ConclusionsThe composition of our MET with an ICU doctor and nurse was reinforced by the need of medical actions in more than half of the situations (either clinical actions or end-of-life decisions). After MET implementation there was a significant decrease in hospital mortality. This study reinforces the benefit of implementing an ICU-MET team.

Effects of introducing a rapid response team in a university teaching hospital – preliminary analysis

“…The analysis mentioned above demonstrated that RRT was most frequently called to assess respiratory efficiency (Figure 1), which is consistent with the observations of some authors who found that the major cause of calls was respiratory disorders [5] and that the main procedure carried out was endotracheal intubation [6]. According to some other authors, however, the most common causes of calls included concerns about the patient condition [6], general bad condition of patients [7], rapid neurological changes [8][9][10].…”

“…Analysis of RRT interventions and evaluation of their effectiveness have been recently studied only in foreign centres, where the RRT counterparts (of different names) have been functioning for a long time [5][6][7][8][9][10]. Since RRTs were introduced in Poland only in 2018, the reports assessing their effectiveness in Poland are lacking.…”

Erfaringer med mobile intensivsykepleiere (MIS)

“…The studies also show that a number of measures are initiated to stabilise such patients, such as intravenous fluids and medicinal treatment (1,11). In a number of European countries and countries such as the USA and Australia, it is the METs and RRTs that handle such patients.…”

“…The most common names of such teams are Medical Emergency Team (MET), Rapid Response Team (RRT), Rapid Response System (RRS) and Critical Care Outreach (CCO) (1)(2)(3)(4). Internationally, the function and composition of such teams vary somewhat, but normally consist of a doctor and a nurse, known as a mobile intensive care nurse (MICN) or a mobile intensive care group (MICG) (5, 6).…”

Rapid response team: what factors interfere with its performance

“…(5) What has been observed is that when the professionals have experience and/ or specialization in intensive care, the teams can achieve better outcomes. (31) In order to improve the RRT responses, tools and instruments have been devised that help professionals in the detection of signs of clinical deterioration, as well as in the team activation process and patient case handoffs.…”