Structured abstract
Background
Many deaths, cardiac arrests, and unplanned intensive care unit (ICU) admissions are preceded by failure to recognize deteriorating vital signs1,2 or trigger intervention.3,4 Furthermore, survival following cardiovascular collapse is low, whereas early response likely improves survival.5,6 As such, in-hospital medical emergency teams (MET) were proposed. Physiologic triggers (see below) lead to their activation.
Objective
The first multi-site prospective MET trial.
Design
Cluster randomized-control trial of 23 Australian hospitals.
Methods
Inclusion criteria were public hospitals with > 20,000 annual admissions, an ICU and emergency department, and no pre-existing MET. Exclusion criteria were patients under14 yr, or not formally admitted. MET activation criteria were: 1) airway: if threatened; 2) breathing: respiratory arrests, respiratory rate < 5 or > 36 breaths·min-1; 3) circulation: cardiac arrests, pulse rate < 40 or > 140, systolic blood pressure < 90 mmHg; 4) neurology: decrease of > 2 Glasgow coma scale points, repeated or extended seizures; 5) other: patients not meeting above criteria but ward staff seriously worried. Cardiac arrests were defined by absence of a palpable pulse; unplanned ICU admission as unscheduled transfer from the ward to the ICU; and unexpected deaths were those without a pre-existing not-for-resuscitation (NFR) order.
Intervention
Hospitals were randomized to no change in current functioning (maintenance of an arrest team) or initiation of MET. This followed four months of instruction for clinical staff in MET hospitals, before a six-month study period. Standardized MET instruction focused on reinforcing MET calling-criteria, the importance of identifying at-risk patients and the need to promptly initiate the MET.
Primary endpoint
Composite outcome of the incidence (events divided by eligible patients admitted to hospital) for 1) cardiac arrests without a NFR; 2) unplanned ICU admission; and 3) unexpected deaths on general wards.
Results
MET initiation was associated with significantly more calls to resuscitation (cardiac arrest or medical emergency) teams (3.1vs 8.7 per 1,000 admissionsP = 0.0001). Only 30% of unplanned ICU admissions were preceded by MET activation, but this was significantly more than 9% for control hospitals (P = 0.009). There was no significant difference in primary outcome (5.86 controlvs 5.31 MET per 1,000 admissions,P = 0.640). There also were no differences in the secondary outcomes: cardiac arrest (1.64vs 1.31 per 1,000 admissionsP = 0.736); unplanned ICU admission (4.68 vs 4.19 per 1,000 admissionsP = 0.599) or unexpected death (1.18vs 1.06 per 100 admissionsP = 0.752). There was a decrease in the rate of cardiac arrests (P = 0.03) and unexpected deaths (P = 0.01) over six months for both the MET and control hospitals.
Conclusions
The MET system greatly increased the frequency of emergency team calling but did not decrease cardiac arrests, unplanned ICU admissions or unexpected death.
Article PDF
Similar content being viewed by others
References
Hillman KM, Bristow PJ, Chey T, et al. Antecedents to hospital deaths. Inter Med J 2001; 31: 343–8.
Kause J, Smith G, Prytherch D, Parr M, Flabouris A, Hillman K;Intensive Care Society (UK);Australian and New Zealand Intensive Care Society Clinical Trials Group. A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and the United Kingdom—the ACADEMIA study. Resuscitation 2004; 62: 275–82.
McQuillan P, Pilkington S, Allan A, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ 1998; 316: 1853–8.
Goldhill DR, White SA, Sumner A. Physiological values and procedures in the 24 h before ICU admission from the ward. Anaesthesia 1999; 45: 529–34.
Rivers E, Nguyen B, Havstad S, et al.;Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368–77.
Bellomo R, Goldsmith D, Uchino S, et al. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med 2004; 32: 916–21.
Bristow PJ, Hillman KM, Chey T, et al. Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team. Med J Aust 2000; 173: 236–40.
Devita MA, Bellomo R, Hillman K, et al. Findings of the first consensus conference on medical emergency teams. Crit Care Med 2006; 34: 2463–78.
Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 2002; 324: 387–90.
De Vita MA, Braithwaite RS, Mahidhara R, et al.;Medical Emergency Response Improvement Team (MERIT). Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care 2004; 13: 251–4.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Brindley, P.G., Simmonds, M. & Gibney, R.T.N. Medical emergency teams: Is there M.E.R.I.T?. Can J Anesth 54, 389–391 (2007). https://doi.org/10.1007/BF03022662
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03022662