Cabrini Health & Deakin University, Cabrini-Deakin Centre for Nursing Research, 183 Wattletree Road, Malvern 3144, Victoria, Australia.
Resuscitation. 2013 Feb;84(2):179-83. doi: 10.1016/j.resuscitation.2012.06.015. Epub 2012 Jul 6.
To determine the point-prevalence of patients fulfilling hospital-specific Medical Emergency Team (MET) criteria and their subsequent outcomes.
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.
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).
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.
确定符合医院特定医疗应急小组（MET）标准的患者的时点患病率及其后续结局。
对 10 家设有 MET 的医院的住院患者进行了前瞻性的时点患病率研究。如果在一组生命体征中出现 MET 标准，将通知病房经理。收集了 MET 激活、非计划性重症监护病房（ICU）入院、心脏骤停、医疗限制（LOMT）、出院和随访死亡率数据。
在纳入的 1688 名患者中，有 3.26%（n=55）在一组生命体征中符合 MET 标准。在通知后的 30 分钟内，没有 55 名患者接受 MET 审查，有 2 名（3.6%）在接下来的 24 小时内接受了 MET 审查，在随访期间没有发生心脏骤停或非计划性 ICU 入院，在符合 MET 激活标准之前，有 13 名（23.6%）患者下达了 LOMT 医嘱。符合 MET 激活标准的患者的院内死亡率明显高于不符合标准的患者（9.1%对 2.6%；p=0.005，RR=2.95；95%置信区间（CI）1.22-7.15），30 天（RR=2.64；95%CI 1.37-5.11）和 60 天（RR=1.94；95%CI 1.11-3.40）的死亡率也较高。没有 LOMT 医嘱的患者 30 天死亡率与没有 MET 标准的患者相似（RR=0.94；95%CI 0.24-3.7）。
在数据收集期间，大约每 30 名住院患者中就有 1 名符合 MET 标准。符合 MET 标准与住院、30 天和 60 天死亡率增加有关，尽管这种增加的死亡率似乎主要归因于临终关怀问题。尽管通知了病房经理，但在这些设有 MET 的医院中，随后的 MET 激活很少发生。需要进一步研究以评估影响工作人员启动 MET 呼叫的因素。
