Critically evaluate the role of the Medical Emergency Team.
Medical Emergency Teams in various formats have been used to manage in-hospital emergencies for over a decade. Despite this, only limited data is available for an evidence- based review. One very large prospective randomised (by hospital) study (MERIT) has been performed but its results have not been published. Various lower levels of evidence are available (eg. before and after intervention studies Goldhill 1999, Buist 2002, Bellomo
2003) and some of these have shown improvements in a number of outcomes (including cardiac arrest rates and improved survival, and length of ICU stay following cardiac arrest). Other studies have also demonstrated trends to improvement in overall mortality and unplanned ICU admissions (Bristow 2000, Kenward 2004). Potential problems associated with implementation include cost (staff, equipment), diversion of staff from other roles, and obvious requirement for appropriate educational strategies.
The MET concept - even in 2005 - was not exactly fresh and new.
However, this question came at a time during which MET research consisted largely of small-scale single centre experiences, which were uniformly positive -largely because they were implemented by enthusiastic and highly motivated personnel. Thus, one can conclude that the early bedside intervention by enthusiastic and highly motivated critical care personnel improves in-hospital survival and prevents cardiac arrest. Subsequent meta-analysis literature was not so favourable. If one applies strict exclusion criteria to the available bank of studies, one is forced to exclude the vast majority on the grounds of poor methodology (just as the Cochrane reviewers did). The remaining high quality data is poxy wih heterogeneity and offers an unsteady foundation upon which to build conclusions.
The answer to this question, compiled from the LITFL review of this topic as well as the relevant evidence from the literature, would ideally look like this:
Evidence in support of the MET system
Evidence against the use of the MET system
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.