Medical emergency team use and outcomes in an Australian private hospital

Introduction

Medical emergency teams (METs) are widespread in Australian public hospitals and are becoming more common in private hospitals. The epidemiology of MET calls and patient outcomes post MET have not been well studied in the private hospital setting.

Methods

Prospective observational study of all inpatient MET calls in a 510-bed private teaching hospital for a 9-month period ending in August 2009. Information was collected on a standard data form after each MET call. Admission, discharge and mortality data were obtained from the hospital administrative database.

Results

There were 302 MET calls and 17,419 admissions with a MET call rate of 1.7% of admissions. Mean (SD) age was 72.9 (17.0) and 42.9% of patients were male. The rate of Code Blue calls was 0.26% and of unexpected (non-NFR) deaths 0.09% of admissions. The MET call rate was higher for medical than surgical patients (2.4% vs 1.1%, P < 0.005). Inpatient mortality was 24.8% and patients receiving a MET call had an increased mean length of stay compared with the hospital average (16.1 vs 5.4 days, P < 0.005). Activation of MET calls was delayed by more than 15 minutes in 7.6% of calls. Of the patients who died, only 16/69 (23%) were transferred to the ICU post MET call. Median (range) time from MET call to death was 1.8 (0 to 76.6) days.

Conclusions

The MET rate in our hospital overall is consistent with a maturing MET system. The higher MET rate in medical vs surgical patients is unexpected compared with the published experience in Australian public hospitals. This may reflect a difference in the patient population or a difference in the pre-MET ward management in our hospital. Whilst inpatient mortality was high, patients who died were mostly managed without transfer to the ICU and the non-NFR death rate was low. This is consistent with a significant overlap between MET and end-of-life care. Alternatively the high mortality could reflect that MET as an intervention occurs too late in these patients to favourably affect outcomes. A more detailed understanding of patients dying after MET calls is required to determine the best ongoing strategy to manage this high-risk group of patients.