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Title: Breaches of pre-medical emergency team call criteria in an Australian hospital.
Austin Authors: Jones, Daryl A ;Kishore, Kartik ;Eastwood, Glenn M ;Sprogis, Stephanie K;Glassford, Neil J
Affiliation: Intensive Care
Data Analytics Research and Evaluation (DARE) Centre
Senior Research Fellow SPHPM, Monash University, Australia.
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.
Monash Health, Clayton Road, Clayton, Australia.;Division of Acute and Critical Care, SPHPM, Monash University, Australia.;Department of Critical Care, Melbourne Medical School, The University of Melbourne, Australia.
Issue Date: Dec-2023
Date: 2023
Publication information: Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine 2023-12; 25(4)
Abstract: 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. Retrospective observational study November 2020-June 2021. Tertiary referral Australian hospital. Adults (≥18 years) experiencing MET calls. 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%). 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.
DOI: 10.1016/j.ccrj.2023.11.002
Journal: Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine
Start page: 223
End page: 228
PubMed URL: 38234322
Type: Journal Article
Subjects: Clinical deterioration
Deteriorating patient
Medical emergency team
Pre-MET tier
Rapid response system
Rapid response team
Urgent clinical review
Appears in Collections:Journal articles

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