Evaluation of a Medical Emergency Team one year after implementation

Aim: To evaluate the activity and impact of a Medical Emergency Team (MET) one year after implementation. Setting and population: A 700-bed District General Hospital (DGH) in Southeast England with approximately 53,500 adult admissions per annum. The population studied included all adult admissions receiving intervention by the MET during a 12-month period between 1 October 2000 and 30 September 2001. Methods: Analysis of the activation of the MET using both prospective and retrospectively acquired data. Routinely collected hospital data for admissions, discharges and deaths was used to compare outcomes for the 12 months before and after the introduction of the MET. Results: There were 136 activations of MET over 1-year. Six cases were excluded. Mean age of patients was 73 years (range 20-97 years). 40% (52/130) survived to discharge following MET intervention. Of those who died 22% (28/130) were designated 'not for resuscitation'. Patients that died were more likely to have three or more physiological abnormalities present (odds ratio, OR 6.2, Chi-square (chi(2)) P = 0.004) and had higher MET scores (P = 0.004). Commonest interventions by the MET were initiation or increase of oxygen therapy or ventilatory support (80%), with or without the administration of intravenous fluids or medications. In 10% of cases, oxygen therapy was the sole intervention. One year after implementation of the MET a reduction in cardiac arrest rate and overall mortality was noted but this was not statistically significant. Conclusion: Often only simple interventions are only required to reverse deterioration. Initiating 'do not attempt resuscitation' (DNAR) decisions is a key part of MET activity. Multiple physiological abnormalities are associated with increased mortality and therefore wider and earlier application of the MET to the hospital population may save lives or expedite DNAR decisions. New systems need time to develop ("bed in") and further research is needed to observe significant reductions in cardiac arrests and overall mortality. (C) 2004 Elsevier Ireland Ltd. All rights reserved.