Abstract
IntroductionMedical emergency teams (MET) are implemented to ensure prompt clinical review of patients with deteriorating physiology with the intention of averting further deterioration, cardiac arrest and death. We sought to determine if MET implementation has led to reductions in hospital mortality across a large metropolitan health network utilising routine administrative data submitted by hospitals to the Department of Health Victoria.MethodsThe Victorian admissions episodes data set (VAED) contains data on all individual hospital separations in the State of Victoria, Australia. After gaining institutional ethics approval, we extracted data on all acute admissions to metropolitan hospitals for which we had information on the presence and timing of a MET system. Using logistic regression we determined whether there was an effect of MET implementation on mortality controlling for age, gender, Charlson comorbidity diagnostic groupings, emergency admission, same day admission, ICU admission, mechanical ventilation, year, indigenous ethnicity, liaison nurse service and hospital designation.Results5911533 individual admissions and 73,599 associated deaths from July 1999 to June 2010 were included in the analysis. 52.2% were male and median age was 57(42-72 IQR). Mortality rates for MET and non-MET periods were 3.92 (3.88-3.95 95%CI) and 4.56 (4.51-4.61 95%CI) deaths per 1000 patient days with a rate ratio after adjustment for year of 0.88 (0.86-0.89 95%CI) P < 0.001. In a multivariable logistic regression, mortality was associated with a MET team being active in the hospital for more than 2 years. The odds ratio for mortality in hospitals where a MET system had been in place for greater than 4 years duration was 0.90 (0.88-0.92). Mortality during the first 2 years of a MET system being in place was not statistically different from pre-MET periods.ConclusionsUtilising routinely collected administrative data we demonstrated that the presence of a hospital MET system for greater than 2 years was associated with an independent reduction in hospital mortality across a major metropolitan health network. Mortality benefits after the introduction of a MET system take time to become apparent.
Highlights
Medical emergency teams (MET) are implemented to ensure prompt clinical review of patients with deteriorating physiology with the intention of averting further deterioration, cardiac arrest and death
Using routinely collected hospital administrative data we have previously reported that the introduction of a MET at our institution was associated with a reduction in all-cause hospital mortality over a number of years [19]
Using routinely collected administrative data we have demonstrated an independent association between the implementation of a hospital MET and a reduction in mortality across a large metropolitan health system
Summary
Medical emergency teams (MET) are implemented to ensure prompt clinical review of patients with deteriorating physiology with the intention of averting further deterioration, cardiac arrest and death. Medical emergency teams (MET) were conceived to provide prompt clinical review of deteriorating patients with the intent of averting further deterioration, cardiac arrest and death [1]. The calling criteria chosen for MET teams have been shown to be associated with increased hospital mortality [2,3] and the intensity of activation based on these criteria is inversely associated with reduction in cardiac arrests [4,5]. MET systems rely on a hospital process made up of an afferent limb, an efferent limb and a management team [7,8]. Establishing a complex system such as this and altering staff attitudes and practice takes time, and this may in part explain some of the variation in efficacy seen in studies [9,10,11]
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