Jones D, Bates S, Warrillow S, Goldsmith D, Kattula A, Way M, Gutteridge G, Buckmaster J, Bellomo R
Clinical Governance Unit, Melbourne University, Austin Hospital, Victoria, Australia.
Intern Med J. 2006 Apr;36(4):231-6. doi: 10.1111/j.1445-5994.2006.01045.x.
Medical Emergency Teams (MET) have been developed to identify, review and manage acutely unwell ward patients. Previous studies have suggested that there may be obstacles to the utilization and activation of the MET.
To determine the effect of a detailed education programme on the rate of utilization of the MET system 3.5 years after its introduction in a University teaching hospital.
Prospective interventional study involving a detailed programme of education, feedback and decision support for nursing and medical staff given before, during and after implementation of a MET system. We measured the number of MET calls per month for both medical and surgical patients for 109 250 consecutive admissions to the acute care campus of Austin Health from August 2000 to June 2004.
Overall activation of the MET increased from 25 calls per month to a peak of 79 calls per month over the study period (average increase of one MET call/month). After standardization for monthly admissions, the increase in MET utilization for surgical patients (increase by 1.13 MET/1000 admissions/month) was 4.9-fold greater than for medical patients (increase by 0.23 MET/1000 admissions/month; P < 0.0001). At the peak level of activity (April 2004), the MET was called to review 8.4% of surgical and 2.7% of medical admissions (P < 0.0001).
There was a progressive increase in the utilization of the MET service in the 3.5 years after implementation, with the rate of uptake 4.9 times greater for surgical than for medical patients. Sustained uptake of the MET system is possible, but increased utilization may take several years to develop. Short-term studies testing the efficacy of the MET system are likely to significantly underestimate its effect on reducing adverse events. Intensive care unit resource adjustments will become necessary to meet increased demand.
医疗应急团队（MET）已被设立，用于识别、评估和管理病房中病情急性加重的患者。此前的研究表明，MET的使用和启动可能存在障碍。
确定一项详细教育计划对一所大学教学医院引入MET系统3.5年后其使用频率的影响。
前瞻性干预研究，在MET系统实施前、实施期间和实施后，为护理和医务人员提供详细的教育、反馈和决策支持计划。我们统计了2000年8月至2004年6月期间奥斯汀健康中心急性护理院区连续109250例内科和外科住院患者每月的MET呼叫次数。
在研究期间，MET的总体启动次数从每月25次增加到每月79次的峰值（平均每月增加1次MET呼叫）。经每月入院人数标准化后，外科患者MET使用率的增加（每1000例入院患者每月增加1.13次MET呼叫）是内科患者的4.9倍（每1000例入院患者每月增加0.23次MET呼叫；P<0.0001）。在活动高峰期（2004年4月），MET被要求对8.4%的外科住院患者和2.7%的内科住院患者进行评估（P<0.0001）。
实施后的3.5年里，MET服务的使用率逐渐上升，外科患者的使用率增长速度是内科患者的4.9倍。MET系统持续被采用是可能的，但使用率的提高可能需要数年时间才能显现。测试MET系统疗效的短期研究可能会显著低估其对减少不良事件的作用。有必要对重症监护病房的资源进行调整，以满足增加的需求。
