Characteristics and Outcomes of Medical Emergency Team (MET) Calls in New Zealand - a Prospective Observational Study

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Patients admitted to hospital wards have increasingly complex conditions and a growing number of co-morbidities. Medical emergency teams (METs) have been introduced into hospitals to identify, review and treat acutely deteriorating ward patients in an attempt to reduce cardiac arrests, serious adverse events and unplanned admissions to the intensive care unit. To date there have been limited studies examining the use of the MET model of care in New Zealand. Knott and others conducted a retrospective cohort study in Wellington, New Zealand. Review by the hospital’s MET was associated with a doubling of documentation of advanced care directives (from 32 before to 64% after MET review). Psirides and others conducted a cross-sectional study of recognition and response systems in NZ public hospitals during October 2011. They found considerable variation in the thresholds for activation of RRTs between hospitals. Pedersen and others have described the models and activities of critical care outreach teams in New Zealand hospitals & have shown considerable variance in the type of work conducted by such teams with variable involvement in responding to deteriorating ward patients. Finally, Drower and co-workers conducted a before and after study to examine the effect of introducing a new vital sign chart, an escalation policy and an expanded response by the cardiac arrest team on the incidence of cardiac arrests in Waikato hospital. They found that this combined approach was associated with a reduction in the incidence of cardiac arrests from 4.67 during 2009– 2010 and 2.91 during 2010–2011 (mean difference of 1.77, 95%CI 0.59–2.94). This study was limited by the presence of a large amount of missing information about emergency calls. To date no study has assessed the characteristics and outcomes of patients subject to MET review in New Zealand. We plan to conduct a multi-centre prospective observational study in New Zealand to assess the characteristics and outcomes of Medical Emergency Team (MET) (or equivalent) calls occurring over a two week period. The term ‘MET’ is used to refer to any hospital system that can be activated to review deteriorating hospital inpatients based on either pre-determined physiological criteria or staff concern. Specifically, we will assess: 1. The variation in the number of MET calls per week between hospitals 2. The timing of these calls – both in relation to time of day, day of week, and in relation to hospital admission. 3. The trigger(s) leading to activation of the MET activation 4. The immediate outcome of the patient at the conclusion of the MET call (cardiac arrest, other death during call, remained on ward, transferred to another ward, admitted to HDU / ICU, other) 5. Details of limitations of medical therapy immediately before and after the call (NFR, for full care, for limited care). 6. Disposition at hospital discharge (home, rehab, other hospital, place other than home, deceased) or whether remained in hospital 30 days after termination of study.

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