Breaches of pre-medical emergency team call criteria in an Australian hospital

Daryl Jones; Kartik Kishore; Glenn Eastwood; Stephanie K Sprogis; Neil J Glassford

doi:10.1016/j.ccrj.2023.11.002

Breaches of pre-medical emergency team call criteria in an Australian hospital

Crit Care Resusc. 2023 Dec 14;25(4):223-228. doi: 10.1016/j.ccrj.2023.11.002. eCollection 2023 Dec.

Authors

Daryl Jones^{1

2

3}, Kartik Kishore⁴, Glenn Eastwood^{5

6}, Stephanie K Sprogis⁷, Neil J Glassford^{8

2

3

9}

Affiliations

¹ Intensive Care Unit, Austin Hospital, Studley Road, Heidelberg, Victoria, 3084, Australia.
² Monash Health, Clayton Road, Clayton, Australia.
³ Division of Acute and Critical Care, SPHPM, Monash University, Australia.
⁴ Bachelor of Technology - Computer Science & Engineering, Data Analytics Research and Evaluation (DARE) Centre, Austin Health, Australia.
⁵ Intensive Care Research Manager, Austin Health, Studley Road, Heidelberg, Germany.
⁶ Senior Research Fellow SPHPM, Monash University, Australia.
⁷ School of Nursing and Midwifery & Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
⁸ Austin Health, Melbourne, Victoria, Australia.
⁹ Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia.

Abstract

Objectives and outcomes: To evaluate the 24hrs before medical emergency team (MET) calls to examine: 1) the frequency, nature, and timing of pre-MET criteria breaches; 2) differences in characteristics and outcomes between patients who did and didn't experience pre-MET breaches.

Design: Retrospective observational study November 2020-June 2021.

Setting: Tertiary referral Australian hospital.

Participants: Adults (≥18 years) experiencing MET calls.

Results: Breaches in pre-MET criteria occurred prior to 1886/2255 (83.6%) MET calls, and 1038/1281 (81.0%) of the first MET calls. Patients with pre-MET breaches were older (median [IQR] 72 [57-81] vs 66 [56-77] yrs), more likely to be admitted from home (87.8% vs 81.9%) and via the emergency department (73.0% vs 50.2%), but less likely to be for full resuscitation after (67.3% vs 76.5%) the MET. The three most common pre-MET breaches were low SpO₂ (48.0%), high pulse rate (39.8%), and low systolic blood pressure (29.0%) which were present for a median (IQR) of 15.4 (7.5-20.8), 13.2 (4.3-21.0), and 12.6 (3.5-20.1) hrs before the MET call, respectively. Patients with pre-MET breaches were more likely to need intensive care admission within 24 h (15.6 vs 11.9%), have repeat MET calls (33.3 vs 24.7%), and die in hospital (15.8 vs 9.9%).

Conclusions: Four-fifths of MET calls were preceded by pre-MET criteria breaches, which were present for many hours. Such patients were older, had more limits of treatment, and experienced worse outcomes. There is a need to improve goals of care documentation and pre-MET management of clinical deterioration.

Keywords: Clinical deterioration; Deteriorating patient; Medical emergency team; Pre-MET tier; Rapid response system; Rapid response team; Urgent clinical review.