MET (Medical Emergency Team)

The role of the acute hospital is changing, patients are no longer seen convalescing and rehabilitating on the wards as in the past. The explosion of knowledge and technology within health has meant that the hospital population is becoming more acute. Patients who would normally have died because of their illness are now surviving as a result of this new era in health.

Some hospitals have adapted to cope with this increasing severity of illness by investing in expensive monitoring systems and specialised units of care such as Intensive Care Units. But what happens to patients that are not in these highly monitored environments, or those who have been transferred to the general ward from these units? The unfortunate reality is, these patients are at risk of serious complications, cardiac arrest and death.

Research has shown that morbidity and mortality rates for in-hospital cardiac arrests have not changed since the invention of cardio-pulmonary resuscitation in the 1960’s, with 90% of all in-hospital cardiac arrest patients dying. Other studies have shown that up to 60–80% of these patients have a slow and well-documented deterioration prior to their arrest. A 30-year review of in-hospital cardiac arrests found that the initial 70% survival to discharge rate post CPR has never been repeated since despite the introduction of cardiac arrest teams.

The clinical effectiveness of cardiac arrest teams has become questionable. The utilisation of a cardiac specific team means that the patient has to arrest before activation occurs. The clinical management of a patient that has life supporting functions is quite different to one that has already died. An acute hospital requires a team that provides EARLY INTERVENTION, TIMELY MANAGEMENT AND APPROPRIATE TREATMENT to ALL IN HOSPITAL EMERGENCIES 24 HOURS A DAY.

This team is The Medical Emergency Team (MET) and has been functioning at Liverpool Hospital since 1990. Any staff member can summon the MET to any hospital emergency, at any time of the day. A patient who requires a MET call is defined by the validated calling criteria. Nursing clinicians become "Physiological Police", and activate the Medical Emergency Team when a patient’s vital signs breach the calling criteria.

The MET system is divided into four major components:

The MET Calling Criteria enables all clinicians to identify seriously ill patients early and activate the MET. This criteria has been validated with specialists across Australia and New Zealand. It is easily identifiable, particularly for nursing staff as they monitor patient’s vital signs on a regular basis.
The MET Response provides clinicians that are trained in advanced resuscitation and acute hospital medicine 24 hours a day. The MET is activated and responded to in the same fashion as the cardiac arrest team. The MET responds within minutes to the emergency so that they can provide swift resuscitation and stabilisation, preventing the patient spiralling into cardiac arrest, being an unanticipated ICU admission or dying.
The Advanced Resuscitation Course (ARC) provides training to clinicians, nurses and doctors, to ensure they have the appropriate skills and knowledge to manage all in hospital emergencies. It is the only course of its type in Australia and teaches skills such as intubation, central access, pleural decompression and intra-osseous needle insertion. The course encourages the utilisation of existing resources; cardiac arrest teams are retrained and become the MET. In small, regional or rural hospitals, the nursing staff are the only available emergency system, training of these staff by the ARC provides an optimal resuscitation service.
The Evaluation and Research of the MET System effectively closes the quality loop. It provides continuous feedback permitting refinement and improvement. Outcome Indicators have been developed to evaluate a hospital’s capability to monitor and treat all patients who are susceptible to critical illness. The four indicators utilised are the Cardiac Arrest Rate, the Unexpected Death Rate, the Unanticipated ICU Admission Rate and the MET Call Rate.

Deaths, Cardiac Arrests and Unanticipated ICU Admissions are adverse patient outcomes that all hospitals and the MET system are trying to prevent. It makes sense that they are utilised as elements of performance for not only the MET, but for the whole hospital. The MET call rate is also utilised, as it is a real time incident monitoring tool.

Preventability is the most important component of these indicators. The indicators are collected in a routine fashion. On review, patients that were expected to die (i.e. have an NFR order) or are admitted as a community arrest are filtered from the auditing. All other events are then retrospectively reviewed for evidence of the MET criteria within the immediate 24hrs prior to the event. If the criteria was present and no action was taken (i.e. MET activated) then the event is deemed as potentially preventable as the MET provides that safety net.

In conclusion, the MET can be seen as a total system, which crosses traditional cultural boundaries between doctors and nurses. As clinicians we demand that we have a 24-hour pathology service, we demand that we have a 24-hour radiology service, should we not demand that we have a 24-hour resuscitation service? As patient advocates we need to take action. Make inquiries about a MET System and form a working party to implement change into your hospital, once again proving that clinicians take the initiatives and provide the care that really counts.

For more information on MET, please contact:

The Simpson Centre for Health Services Research
Liverpool Health Service
Locked Bag 7103
Liverpool BC NSW 1871

Tel: +61(2) 9612 0635
Fax: +61(2) 9612 0746
Email: simpsoncentre@swsahs.nsw.gov.au