Do surgeons need to look after unwell patients? The role of medical emergency teams

Abstract

Medical emergency teams (MET) have been shown to reduce in-hospital morbidity and mortality of surgical patients. The present study reviews the experience with the use of MET in the care of critically unwell surgical patients. Data were prospectively collected on all patients in a general surgical unit of a tertiary referral centre meeting the criteria for activating a MET over a 6 month period. These data were retrospectively analysed with respect to surgical team and MET involvement in the care of these patients. Over the 6 month study period, 22 patients qualified for a MET response based on criteria of physiological instability. A MET was activated for 13 of these patients (59%), with the remainder being managed by direct consultation with intensive care and medical staff. Forty-six per cent of MET activations were outside of normal working hours. Respiratory distress including tachypnoea and desaturation was the most commonly identified physiological abnormality (13 patients), accounting for 62% of MET activations. A MET was activated by a surgical registrar in 46% of cases. Seventy-seven per cent of MET activations were preceded by at least one registrar level assessment without resolution of the patient's clinical deterioration. The most common MET interventions were supplementation of oxygen therapy and initiation of pharmacotherapy (11 patients). The surgical team complemented the MET response by providing detailed information regarding the patient's surgical condition, premorbid status (13 patients), organized transfer to the operating theatre (three patients), initiated blood transfusions (two patients) and deciding to order abdominal computed tomography (two patients). Urgent surgical decision making was required in 23% of MET activations. Medical emergency team activations for critically unwell surgical patients are complemented by surgical team involvement in the decision making and management process. The MET may be underutilized in the management of unwell surgical patients.