Medical emergency response training. Can we make a difference?

Abstract

Introduction: In the last year, clinically deteriorating patients triggered 3700 Medical Emergency Response Team (MERT) activations in a tertiary hospital. The responding team consists of junior doctors from intensive care and medicine and nursing staff. Training deficits have been identified in confidential surveys completed annually by 74 specialists and 210 team responders since 2017. Of the responding MERT team 139 (66%) had less than 3 years’ clinical experience, 181 (86%) had felt inadequately prepared attending a MER and 193 (92%) requested more training. A MERT course commenced in 2019 endorsed by the governance committee for acute deterioration, addressing National Standard Eight and CICM minimum standards for training. Objectives/Aims: To improve clinician confidence and ability to manage clinical deterioration by introducing a 1-day simulation based MERT course focusing on enhancing technical and non-technical skills. Methods: Doctors completed post-course evaluation forms and global staff surveys were completed from 2017-2019. Results: Post course evaluation reported 35 (100%) of participants enjoyed the course, identified clear learning objectives, reported improved knowledge. All participants felt more confident managing a MER and that it had changed their practice. Thirty-four (97.5%) would recommend the course to others. After commencing the course, the global staff survey demonstrated the number of trainees requesting training fell from 92% to 64% post (p=<0.001). Reported bedside conflict post-course halved from 66% to 34%, with fewer triggers for conflict 2.8 from 4.7 per responder (Likert scale 1-4) p=<0.001. Barriers to escalation fell from 2.98 to 2.03 (Likert scale) and trainees reported more senior support after hours (p=<0.05). More patients had documented advanced resuscitation planning following training 2.1 from 1.85 (Likert scale 1-4). Conclusion: It cannot be assumed that doctors have the core technical and non-technical skills required to confidently deliver high quality care. The MERT course is standardising and improving patient care.