Medical emergency teams had become widespread in the nineties. The state of play right now is such that most people can neither clearly remember a time when there was no such service, or are too young to conceive of what an ICU job would look like without such a service.
Question 7 from the first paper of 2001 asked about the elements of a MET system and the expected improvements from such a system (implying that improvements were expected), whereas the later Question 12 from the first paper of 2005 asked the trainees to critically evaluate the system without pointing them to any specific conclusion they were supposed to reach.
Of all the possible resources, the most important reading for this topic is probably LITFL, followed by the Oh's Manual chapter (Ch.2, Welch and Subbe) and the 2004 article by Bright et al. Plus, a recent "JOINT POSITION STATEMENT" from the college has an all-capitals title, which makes it sound very urgent and important. We can expect to see more of this in the coming papers, and this is a good candidate for an SAQ.
This is the concept of "ICU without walls", which some uncivilized individuals have extrapolated to "ICU without balls" and "ICU without arms or legs", implying that the extension of critical care services will steal staff from the ICU and make us everybody's bitch, expected to clean up the mess of wealthy interventional specialties who neglect their ward work. These rude people clearly do not represent the opinions of the examiners, who seem to largely be in favour of the MET system (judging by their model answers). The Oh's chapter on this topic certainly seems pro-outreach in its tone, while trying to remain neutral.
Definition of a Rapid Response System (RRS)
The purpose of these outreach teams
Members of these teams
Skills deployed by outreach team members
Advantages
Disadvantages
Evidence in support of critical care outreach teams
Evidence against critical care outreach teams
Rationale
Advantages
Disadvantages
Evidence in support of the MET system
Evidence against the use of the MET system
Boots, Rob, et al. "JOINT POSITION STATEMENT ON RAPID RESPONSE SYSTEMS IN AUSTRALIA AND NEW ZEALAND AND THE ROLES OF INTENSIVE CARE."
Ball, Carol, Margaret Kirkby, and Susan Williams. "Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study." Bmj 327.7422 (2003): 1014.
Niven, Daniel J., Jaime F. Bastos, and Henry T. Stelfox. "Critical Care Transition Programs and the Risk of Readmission or Death After Discharge From an ICU: A Systematic Review and Meta-Analysis*." Critical care medicine 42.1 (2014): 179-187.
Cuthbertson, Brian H. "The impact of critical care outreach: is there one?" Critical Care 11.6 (2007): 179.
Esmonde, Lisa, et al. "Investigating the effectiveness of critical care outreach services: a systematic review." Intensive care medicine 32.11 (2006): 1713-1721.
Pirret, Alison M. "The role and effectiveness of a nurse practitioner led critical care outreach service." Intensive and Critical Care Nursing 24.6 (2008): 375-382.
Fletcher, S. J., and B. H. Cuthbertson. "Outreach, epistemology and the evolution of critical care." Anaesthesia 65.2 (2010): 115-118.
Fletcher, S. J., and B. H. Cuthbertson. "Outreach, epistemology and the evolution of critical care." Anaesthesia 65.2 (2010): 115-118.
Marsh, Sarah, and Alison Pittard. "Outreach:‘the past, present, and future’."Continuing Education in Anaesthesia, Critical Care & Pain (2012): mkr062.
Hutchings, Andrew, et al. "Evaluation of modernisation of adult critical care services in England: time series and cost effectiveness analysis." BMJ 339 (2009).
MET teams:
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.
Bright, Debby, Wendy Walker, and Julian Bion. "Clinical review: outreach–a strategy for improving the care of the acutely ill hospitalized patient." Critical Care 8.1 (2003): 1.