Evaluation of medical emergency team activations in patients with limitations-of-medical-therapy: A retrospective cohort study

Abstract

Rationale: Utilization of the medical emergency team (MET) and associated outcomes in patients with limitations-of-medical-therapy (LOMT) are not well understood. Objectives: We aimed to describe and compare characteristics and outcomes following MET activation in patients with and without LOMT. Methods, Measurements and Main Results: Retrospective cohort study of 2,118 adult in-patients with a MET activation between January 1, 2013, to December 31, 2015, at the University of Alberta Hospital in Edmonton, Canada. There were 2,703 MET activations in 2,118 patients. Four hundred sixty-one patients (21%) had LOMT at the time of MET activation. Of these, 268 (58%) died in-hospital, 40% within 24 hours of their last MET activation. Compared to patients with no LOMT, patients with LOMT were older (78 vs. 63 years; p < 0.001), more likely to be female (48% vs. 42%; p < 0.01), had a higher comorbidity index score (6 vs. 5; p < 0.001) and more often admitted to a medical service (66% vs. 45%; p < 0.001). A LOMT was associated with 3.49 greater odds (95% CI: 2.79- 4.36) of in-hospital mortality following MET activation. Conclusions: MET activations in hospitalized patients with preexisting LOMT are common. The findings suggest greater need for understanding the role of MET services for patients with LOMT, particularly nearing end-of-life. Supplemental data for this article is available online at https://doi.org/10.1080/24745332.2021.2022549