Characteristics and outcomes of patients receiving review requests for pre-medical emergency team deterioration: a cohort study.

Abstract

Objective The aim of this study was to describe the epidemiology of pre-medical emergency team (pre-MET) reviews, including patient characteristics, the frequency and nature of triggers and interventions and in-hospital outcomes. Methods An exploratory retrospective cohort study was performed using a medical record audit. Fifty orthopaedic and general medicine patients at a hospital in Melbourne, Australia, with requests for pre-MET reviews in 2016 were included. Descriptive analyses were performed. Results The median patient age was 80 years (interquartile range 19 years). Most patients were female (64%), general medical patients (82%), with limitation of medical treatment orders (52%) and modified pre-MET triggers (42%). Documented pre-MET reviews occurred for 68% of requests. Tachypnoea (24%) and staff worry (24%) were the most common pre-MET triggers. One-third of patients received two clinical interventions. One in five patients had repeat requests for a pre-MET review within 12 h. In-hospital mortality was 12%. Conclusions Most requests for pre-MET reviews related to older female patients. Clinician adherence to pre-MET policy was variable. Multicentre studies are needed to inform improvements to pre-MET strategies. What is known about the topic? Australian hospitals have introduced multi-tiered rapid response systems (RRSs) that consist of pre-MET review to comply with accreditation standards. Pre-MET reviews are triggered by early signs of clinical deterioration and are provided by admitting medical teams or senior nurses. There is limited understanding of the characteristics and outcomes of patients receiving pre-MET reviews for early clinical deterioration. What does this paper add? In a cohort of orthopaedic and general medicine patients, most patients receiving requests for pre-MET reviews were older, female medical patients, with existing modifications to pre-MET triggers. Most requests for pre-MET review were for tachypnoea or staff worry; the latter included clinical problems not addressed by predefined organisational triggers. One in five patients continued to deteriorate within 12 h of the pre-MET request. Clinician adherence to pre-MET policy varied. What are the implications for practitioners? Patients in this study frequently deteriorated in ways that did not breach predefined pre-MET triggers, demonstrating that pre-MET requests are made for a range of clinical concerns. Doctors and nurses must be vigilant for ongoing clinical deterioration in patients receiving requests for pre-MET reviews. Reflecting the timing of the recent introduction of the pre-MET review system, variable adherence to pre-MET policy raises questions about clinicians' awareness of and responsibilities in this RRS tier, the impact of workloads on RRS response capability and the suitability of existing escalation policies. Evaluation of the implementation of pre-MET review is warranted.