What are the important elements of a Medical Emergency Team (MET) program?
How may a MET improve in-hospital morbidity and mortality?
A discussion or debate about the role of MET was not sought. It required a simple statement about theoretical structure and advantage.
(a) The important elements of the MET team include:
- call criteria for alerting the team to a sick patient
- education of ward staff to recognise deteriorating patient condition
- effective training and composition of MET team with diagnostic and procedural skills
- review of calls, aggregation of data and follow-up
(b) How may this improve in-hospital morbidity and mortality: early signs of deteriorating function leading to cardiac arrest and death have been identified. Early intervention will prevent irreversible organ damage. In most studies 50-60% of patients were admitted to hospital with a respiratory illness. Early intervention in a deteriorating patient will prevent an hypoxic/hypercarbic arrest.
Education and increased awareness of all staff of the signs and symptoms of critical illness leads to improved management of these patients.
This question closely resembles Question 12 from the first paper of 2005, which asks the candidates to critically evaluate the role of the MET team. However, in their answer, the college sternly warn us that "a discussion or debate about the role of MET was not sought".
So: here is a simple statement about theoretical structure and advantage of a MET program
Organisation of MET program:
Membership of the Medical Emergency Team:
This is merely a suggestion
Quality assurance
Theoretical advantages:
Goldhill, D. R., et al. "The patient-at-risk team: identifying and managing seriously ill ward patients." ANAESTHESIA-LONDON- 54 (1999): 853-860.
Hillman, Ken, et al. "Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial." Lancet 365.9477 (2005): 2091-2097.
McGaughey, Jennifer, et al. "Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards." Cochrane Database Syst Rev 3 (2007).
Howell, Michael D., et al. "Sustained effectiveness of a primary-team–based rapid response system." Critical care medicine 40.9 (2012): 2562.
Buist, Michael D., et al. "Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study." Bmj 324.7334 (2002): 387-390.
Bellomo, Rinaldo, et al. "A prospective before-and-after trial of a medical emergency team." Medical Journal of Australia 179.6 (2003): 283-288.