Medical emergency teams are associated with reduced mortality across a major metropolitan health network after two years service: a retrospective study using government administrative data

Abstract

IntroductionMedical emergency teams (MET) are implemented to ensure prompt clinical review of patients with deteriorating physiology with the intention of averting further deterioration, cardiac arrest and death. We sought to determine if MET implementation has led to reductions in hospital mortality across a large metropolitan health network utilising routine administrative data submitted by hospitals to the Department of Health Victoria.MethodsThe Victorian admissions episodes data set (VAED) contains data on all individual hospital separations in the State of Victoria, Australia. After gaining institutional ethics approval, we extracted data on all acute admissions to metropolitan hospitals for which we had information on the presence and timing of a MET system. Using logistic regression we determined whether there was an effect of MET implementation on mortality controlling for age, gender, Charlson comorbidity diagnostic groupings, emergency admission, same day admission, ICU admission, mechanical ventilation, year, indigenous ethnicity, liaison nurse service and hospital designation.Results5911533 individual admissions and 73,599 associated deaths from July 1999 to June 2010 were included in the analysis. 52.2% were male and median age was 57(42-72 IQR). Mortality rates for MET and non-MET periods were 3.92 (3.88-3.95 95%CI) and 4.56 (4.51-4.61 95%CI) deaths per 1000 patient days with a rate ratio after adjustment for year of 0.88 (0.86-0.89 95%CI) P < 0.001. In a multivariable logistic regression, mortality was associated with a MET team being active in the hospital for more than 2 years. The odds ratio for mortality in hospitals where a MET system had been in place for greater than 4 years duration was 0.90 (0.88-0.92). Mortality during the first 2 years of a MET system being in place was not statistically different from pre-MET periods.ConclusionsUtilising routinely collected administrative data we demonstrated that the presence of a hospital MET system for greater than 2 years was associated with an independent reduction in hospital mortality across a major metropolitan health network. Mortality benefits after the introduction of a MET system take time to become apparent.

Intensive care readmission: A contemporary review of the literature

“…Critical Care Outreach Teams have been demonstrated to decrease the proportion of patients admitted to ICU who received cardiopulmonary resuscitation prior to admission (Harrison et al, 2004). Medical Emergency Teams have been associated with an independent reduction in hospital mortality (Tobin and Santamaria, 2012).…”

Failure to activate the in-hospital emergency team: causes and outcomes

“…(6-8) These systems have afferent and efferent limbs, regardless of the model. The afferent limb consists of clinical monitoring and surveillance, the detection of patient clinical deterioration, the knowledge of the Medical Emergency Team (MET) activation criteria and its activation.…”

Timing and Location of Medical Emergency Team Activation Is Associated with Seriousness of Outcome: An Observational Study in a Tertiary Care Hospital

“…Such an analysis involved adjustment for potential confounding factors based on biological plausibility and previous studies [14–19] using a cut-off P -value < 0.1 in the univariate analysis of baseline characteristics (variables: age, patient status [inpatient or not], cardiovascular diagnosis, medical history [postoperative, post ICU discharge, sepsis on MET activation], chronic heart failure, and chronic kidney disease).…”