Deakin University, School of Nursing and Midwifery & Centre for Quality and Patient Safety in the Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria, 3220, Australia.
Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia; School of Public Health and Preventive Medicine, Monash University, 533 St Kilda Road, Melbourne, Victoria, 3004, Australia; Department of Surgery, University of Melbourne, Parkville, Victoria, 3010, Australia.
Aust Crit Care. 2023 Nov;36(6):1050-1058. doi: 10.1016/j.aucc.2023.01.010. Epub 2023 Mar 21.
The pre-medical emergency team (pre-MET) tier of rapid response systems facilitates early recognition and treatment of deteriorating ward patients using ward-based clinicians before a MET review is needed. However, there is growing concern that the pre-MET tier is inconsistently used.
This study aimed to explore clinicians' use of the pre-MET tier.
A sequential mixed-methods design was used. Participants were clinicians (nurses, allied health, doctors) caring for patients on two wards of one Australian hospital. Observations and medical record audits were conducted to identify pre-MET events and examine clinicians' use of the pre-MET tier as per hospital policy. Clinician interviews expanded on understandings gained from observation data. Descriptive and thematic analyses were performed.
Observations identified 27 pre-MET events for 24 patients that involved 37 clinicians (nurses = 24, speech pathologist = 1, doctors = 12). Nurses initiated assessments or interventions for 92.6% (n = 25/27) of pre-MET events; however, only 51.9% (n = 14/27) of pre-MET events were escalated to doctors. Doctors attended pre-MET reviews for 64.3% (n = 9/14) of escalated pre-MET events. Median time between escalation of care and in-person pre-MET review was 30 min (interquartile range: 8-36). Policy-specified clinical documentation was partially completed for 35.7% (n = 5/14) of escalated pre-MET events. Thirty-two interviews with 29 clinicians (nurses = 18, physiotherapists = 4, doctors = 7) culminated in three themes: Early Deterioration on a Spectrum, A Safety Net, and Demands Versus Resources.
There were multiple gaps between pre-MET policy and clinicians' use of the pre-MET tier. To optimise use of the pre-MET tier, pre-MET policy must be critically reviewed and system-based barriers to recognising and responding to pre-MET deterioration addressed.
医疗前紧急小组（pre-MET）作为快速反应系统的一个层级，通过让驻科临床医生在需要 MET 审查之前及早识别和治疗病情恶化的病房患者，促进了这方面的工作。然而，人们越来越担心 pre-MET 层级的使用不一致。
本研究旨在探讨临床医生使用 pre-MET 层级的情况。
采用序贯混合方法设计。参与者为照顾一家澳大利亚医院两个病房患者的临床医生（护士、辅助医疗人员、医生）。通过观察和病历审核来识别 pre-MET 事件，并按照医院政策检查临床医生对 pre-MET 层级的使用情况。临床医生访谈则对观察数据中获得的理解进行了扩展。进行了描述性和主题分析。
观察共确定了 24 名患者的 27 次 pre-MET 事件，涉及 37 名临床医生（护士 24 名，言语治疗师 1 名，医生 12 名）。护士对 92.6%（n=25/27）的 pre-MET 事件进行了评估或干预；然而，只有 51.9%（n=14/27）的 pre-MET 事件升级为医生处理。医生对 64.3%（n=9/14）的升级 pre-MET 事件进行了 pre-MET 审查。从护理升级到面对面 pre-MET 审查的中位时间为 30 分钟（四分位距：8-36）。有 35.7%（n=5/14）的升级 pre-MET 事件部分完成了政策规定的临床记录。对 29 名临床医生（护士 18 名，物理治疗师 4 名，医生 7 名）进行了 32 次访谈，最终形成了三个主题：范围广泛的早期恶化、安全网、需求与资源。
pre-MET 政策与临床医生对 pre-MET 层级的使用之间存在多个差距。为了优化 pre-MET 层级的使用，必须对 pre-MET 政策进行严格审查，并解决识别和应对 pre-MET 恶化方面的系统障碍。
