Medical Emergency Team

Published Date: 19th July 2016

Publication Authors: Elmore J, Mahambrey T

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Abstract

In January 2011 a multidisciplinary hospital-wide medical emergency team (MET) was introduced at Whiston Hospital replacing the previous cardiac arrest team. The primary aim of this new rapid-response service was to improve early identification and management of deteriorating patients, with a reduction in unplanned intensive care (ICU) admissions, cardiac arrest calls and unexpected patient death. The impact of the new service was evaluated using key performance indicators including cardiac arrest rate, unplanned ICU admissions and hospital mortality. Audit data were collected prospectively at every MET call. ICU admission data were provided by ICNARC (Intensive Care National Audit and Research Centre) and cardiac arrest data by the National Cardiac Arrest Audit (NCAA). Hospital Standardised Mortality Ratios (HSMR-56 and HSMR-All Diagnosis) were calculated monthly from Dr Foster data. We analysed and compared March to September 2011 (pre- MET) with March to September 2012 (post-MET). A total of 1,122 MET interventions took place for 761 patients over six months (mean 6.1 calls per day). In-hospital mortality for patients receiving a single MET intervention was 33.7% rising to 60.9% for those receiving three MET interventions. Cardiac arrest rates after MET was introduced remained in the lowest third nationally, with a small nonsignificant reduction from the previous year (1.38/1000 vs 1.32/1000 admissions). There were more unplanned ICU admissions (186 vs 213), and time interval between hospital admission and ICU admission was reduced (7.2 vs 4.1 days, p=0.01). Mean duration of intensive care stay was reduced for Level 2 (p=0.07) and Level 3 (p=0.24) patients. HSMR [all diagnosis] was below national average following MET introduction for all six months analysed. This was an improvement when compared to before MET in all but one month. A modest reduction in overall hospital mortality and cardiac arrest rate after the introduction of MET was observed. While encouraging, this must be sustained in future audit to convincingly support a causal association. Unplanned intensive care admissions occurred more quickly supporting improvement in the identification of deteriorating patients. The high mortality of patients requiring multiple MET interventions echoes previous published data and highlights the need for prompt senior decision-making.

Gilmore, AJ; Kelly, M; Elmore, J; Mahambrey, T. (2014).  The first year of a new medical emergency team (MET): Implementation and service evaluation . Journal of the Intensive Care Society. 15 (Suppl 1), S39

 

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