A physician-led medical emergency team increases the rate of medical interventions: A multicenter study in Korea.

Su Yeon Lee,Byung Ju Kang,Sang-Bum Hong,Sang-Min Lee,Yeon Joo Lee,Kyeongman Jeon,Jisoo Park,Jung Soo Kim,Jee Hwan Ahn,Jae Young Moon,Dong Hyun Lee,Amit Bahl

doi:10.1371/journal.pone.0258221

Abstract

BackgroundAccording to the rapid response system’s team composition, responding teams were named as rapid response team (RRT), medical emergency team (MET), and critical care outreach. A RRT is often a nurse-led team, whereas a MET is a physician-led team that mainly plays the role of an efferent limb. As few multicenter studies have focused on physician-led METs, we comprehensively analyzed cases for which physician-led METs were activated.MethodsWe retrospectively analyzed cases for which METs were activated. The study population consisted of subjects over 18 years of age who were admitted in the general ward from January 2016 to December 2017 in 9 tertiary teaching hospitals in Korea. The data on subjects’ characteristics, activation causes, activation methods, performed interventions, in-hospital mortality, and intensive care unit (ICU) transfer after MET activation were collected and analyzed.ResultsIn this study, 12,767 cases were analyzed, excluding those without in-hospital mortality data. The subjects’ median age was 67 years, and 70.4% of them were admitted to the medical department. The most common cause of MET activation was respiratory distress (35.1%), followed by shock (11.8%), and the most common underlying disease was solid cancer (39%). In 7,561 subjects (59.2%), the MET was activated using the screening system. The commonly performed procedures were arterial line insertion (17.9%), intubation (13.3%), and portable ultrasonography (13.0%). Subsequently, 29.4% of the subjects were transferred to the ICU, and 27.2% died during hospitalization.ConclusionsThis physician-led MET cohort showed relatively high rates of intervention, including arterial line insertion and portable ultrasonography, and low ICU transfer rates. We presume that MET detects deteriorating patients earlier using a screening system and begins ICU-level management at the patient’s bedside without delay, eventually preventing the patient’s condition from worsening and transfer to the ICU.

Highlights

The rapid response system (RRS) was first introduced in Australia and the United States in the mid-1990s [1]
29.4% of the subjects were transferred to the intensive care unit (ICU), and 27.2% died during hospitalization
We presume that medical emergency team (MET) detects deteriorating patients earlier using a screening system and begins ICU-level management at the patient’s bedside without delay, eventually preventing the patient’s condition from worsening and transfer to the ICU

Summary

Introduction

The rapid response system (RRS) was first introduced in Australia and the United States in the mid-1990s [1]. According to team composition, responding teams were named as the rapid response team (RRT), medical emergency team (MET), and critical care outreach (CCO) [3]. RRTs and CCO are often nurse-led, whereas the MET is a physician-led team that mainly plays the role of an efferent limb of the RRS [3,5]. According to the MERIT study published in 2005, the introduction of the MET did not reduce the incidence of cardiac arrests, unplanned ICU admissions, or unexpected deaths [7]. According to the rapid response system’s team composition, responding teams were named as rapid response team (RRT), medical emergency team (MET), and critical care outreach. A RRT is often a nurse-led team, whereas a MET is a physician-led team that mainly plays the role of an efferent limb. As few multicenter studies have focused on physician-led METs, we comprehensively analyzed cases for which physician-led METs were activated

Methods

Results

Conclusion