PURPOSE: To evaluate if the number and type of objective criteria met at the time of medical emergency team (MET) activation discriminates the patient’s need for critical care.
METHODS: Our hospital, a 600 bed tertiary care center in Phoenix, AZ, implemented a MET in March 2005. The MET was employed from 7:00 pm to 7:00 am, 7 days per week in non-ICU patient care areas. Objective criteria denoting physiologic derangement were used by frontline providers to trigger a call to the MET. Data collected prospectively on MET calls included demographics, patient history, problem assessment, treatments initiated and disposition of the patient. ANOVA was used to evaluate differences between average number of criteria met and patient disposition after MET assessment. Logistic regression analysis was used to identify which criteria predicted ICU transfer.
RESULTS: The MET team responded to 158 calls in 339 nights. Fifty percent of these patients required transfer to the ICU, 10% required transfer to a non-ICU higher level of care, 33% stayed in the same location, and 3% expired during the MET response. The average number of MET activation criteria fulfilled by patients transferring to an ICU was 2.3, while patients who were able to remain in their room met an average of 1.5 criteria (F=11.75,p<.0001). Two criteria, respiratory rate greater than 24 and SpO2 < 90, were independent predictors of ICU transfer. Further, Odds ratios indicated that patients with tachypnea were 3 times more likely to require transfer to a higher level of care and hypoxic patients were 2 times more likely.
CONCLUSION: Patients meeting more than one objective criteria for activation of our MET at the time of the call are more likely to need critical care, especially if the patient is hypoxic or tachypneic.
CLINICAL IMPLICATIONS: Educating frontline providers on the signs of early physiologic deterioration and encouraging early activation of the MET based on set physiologic criteria may further improve MET effectiveness and prevent patient deterioration into critical illness.
DISCLOSURE: Rebecca Legg, None.