Question 7

College Answer

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.

Discussion

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:

• Calling criteria to protocolise the recognition of the deteriorating patient
• Education of ward staff to use the calling criteria protocol
• Rostering of 24/7 staff to act as members of the MET team

Membership of the Medical Emergency Team:

This is merely a suggestion

• Medical team leader
• Medical staff skilled in airway management (eg. anaesthetics staff or ICU staff)
• Medical staff skilled in vascular access (eg. anaesthetics staff or ICU staff)
• Junior medical officer
• Nursing Team Leader
• Wardsperson
• Administrative (bed management) staff to facilitate transfer

Quality assurance

• Database of MET calls
• Regular audit of MET calls
• Regular multidisciplinary review of trends in MET call events
• Follow-up of patients who were the subjects of a MET call

Theoretical advantages:

• Call criteria are simple parameters to measure, already routinely collected
• Potentially, lifesaving treatments can be administered at the appropriate moment
• Early intervention to prevent cardiac arrest is likely to improve hospital mortality
• MET services deploy an ICU-level skill set in the ward, which should improve the quality of care for critically ill patients
• Prevention of ICU admission should be a cost-effective measure, working on the premise that ICU admission is more costly than MET team maintenance.
• End-of-life care quality should improve with the involvement of ICU staff

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.