Responding to medical emergencies: system characteristics under examination (RESCUE). A prospective multi-site point prevalence study.

AIM

To determine the point-prevalence of patients fulfilling hospital-specific Medical Emergency Team (MET) criteria and their subsequent outcomes.

METHOD

Inpatients from 10 hospitals with established METs were enrolled for a prospective, point-prevalence study. If MET criteria were present during a set of vital signs, the ward manager was notified. MET activations, unplanned Intensive Care Unit (ICU) admissions, cardiac arrests, Limitations of Medical Treatment (LOMT), hospital discharge and follow-up mortality data were collected.

RESULTS

Of 1688 patients recruited, 3.26% (n=55) fulfilled MET criteria in a single set of vital signs. None of the 55 received MET review within 30 min of notification, 2 (3.6%) had MET review within the next 24h, none experienced cardiac arrests or unplanned ICU admissions during the follow-up period, and 13 (23.6%) had a LOMT order prior to fulfilling MET criteria. In-hospital mortality was significantly higher for patients fulfilling MET activation criteria (9.1%) compared to those that did not (2.6%; p=0.005, RR=2.95; 95% confidence interval (CI) 1.22-7.15), as was mortality at 30 days (RR=2.64; 95% CI 1.37-5.11) and 60 days (RR=1.94; 95% CI 1.11-3.40). The 30 day mortality in patients without an LOMT order was similar to patients without MET criteria (RR=0.94; 95% CI 0.24-3.7).

CONCLUSIONS

Approximately 1 in 30 hospitalised patients fulfilled MET criteria during data collection. The presence of MET criteria was associated with increased hospital, 30 and 60 day mortality, although much of this increased mortality seemed to be due to issues around end-of-life care. Despite ward manager notification, subsequent MET activation occurred infrequently in these hospitals with established METs. Further research is needed to assess factors that influence staff initiation of a MET call.