Pre-medical emergency team activations - Patient characteristics, outcomes and predictors of deterioration

Sing Chee Tan; Lachlan Hayes; Anthony Cross; Mark Tacey; Daryl Jones

doi:10.1016/j.aucc.2023.03.002

Pre-medical emergency team activations - Patient characteristics, outcomes and predictors of deterioration

Aust Crit Care. 2023 Nov;36(6):1078-1083. doi: 10.1016/j.aucc.2023.03.002. Epub 2023 Apr 17.

Authors

Sing Chee Tan¹, Lachlan Hayes², Anthony Cross³, Mark Tacey⁴, Daryl Jones⁵

Affiliations

¹ Faculty of Engineering and Information Technology, The University of Melbourne, Parkville, VIC 3010, Australia; Department of Intensive Care, Northern Health, Epping, Victoria, Australia; Division of Digital Health, Northern Health, Epping, Victoria, Australia. Electronic address: singct@student.unimelb.edu.au.
² Division of Digital Health, Northern Health, Epping, Victoria, Australia.
³ Department of Intensive Care, Northern Health, Epping, Victoria, Australia; Centre for Integrated Critical Care, University of Melbourne, Carlton, Victoria, Australia.
⁴ Office of Research, Northern Health, Epping, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia.
⁵ Department of Surgery, University of Melbourne, Carlton, Victoria, Australia; Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia.

PMID: 37076387
DOI: 10.1016/j.aucc.2023.03.002

Abstract

Background: Pre-medical emergency team (MET) calls are an increasingly common tier of Rapid Response Systems, but the epidemiology of patients who trigger a Pre-MET is not well understoof.

Objectives: This study aims to examine the epidemiology and outcomes of patients who trigger a pre-MET activation and identify risk factors for further deterioration.

Methods: This is a retrospective cohort study of pre-MET activations in a university-affiliated metropolitan hospital in Australia, between 13 April 2021 and 4 October 2021. A multivariable regression model was used to identify variables associated with further deterioration, defined as a MET call or Code Blue within 24 h of pre-MET activation.

Results: From a total of 39 664 admissions, there were 7823 pre-MET activations (197.2 per 1000 admissions). Compared to inpatients that did not trigger a pre-MET, the patients were older (68.8 vs 53.8 years, p < 0.001), were more likely to be male (51.0 vs 47.6%, p < 0.001), had an emergency admission (70.1% vs 53.3%, p < 0.001), and were under a medical specialty (63.7 vs 54.9%, p < 0.001). They had a longer hospital length of stay (5.6 vs 0.4 d, p < 0.001) and higher in-hospital mortality (3.4% vs 1.0%, p < 0.001). A pre-MET was more likely to progress to a MET call or Code Blue if it was activated for fever, cardiovascular, neurological, renal, or respiratory criteria (p < 0.001), if the patient was under a paediatric team (p = 0.018), or if there had been a MET call or Code Blue prior to the pre-MET activation (p < 0.001).

Conclusion: Pre-MET activations affect almost 20% of hospital admissions and are associated with a higher risk of mortality. Certain characteristics may predict further deterioration to a MET call or Code Blue, suggesting the potential for early intervention via clinical decision support systems.

Keywords: Clinical deterioration; Medical emergency team; Pre-MET; Rapid response system; Rapid response team; Tiered escalation.

MeSH terms

Australia
Cardiopulmonary Resuscitation*
Child
Female
Hospital Mortality
Hospital Rapid Response Team*
Hospitalization
Humans
Male
Retrospective Studies