A prospective before-and-after trial of a medical emergency team

To the Editor: The introduction of a medical emergency team (MET) at the Austin Hospital significantly reduced cardiac arrest and deaths, and reduced time spent by survivors of cardiac arrest in the intensive care unit (ICU) and in hospital.1

We note that the evaluation of the MET was preceded by a 12-month period of education and a 2-month “run-in” period before the effects of the MET were analysed. We would be interested to know the incidence of death and cardiac arrest, and the duration of ICU and hospital admission in survivors of cardiac arrest during these two periods.

Another MET service also claimed substantial benefits in patient outcomes,2 but was criticised on the basis that the results may have been due to better education of ward staff in recognising the antecedent signs of cardiac arrest and/or the creation of more “do-not-resuscitate” orders.3 While the latter criticism cannot be levelled at the study by Bellomo et al, no attempt is made to separate out the effects of the lengthy education period and the operation of the MET. This is a pity, because it would have been a relatively simple matter to do so without detracting from the obvious benefit of the service.

Why was a 2-month “run-in” period between education and operation of the MET allowed before analysis of results? Was this a post-hoc decision or were there foreseeable difficulties during the introduction of the MET?

Did patient outcomes change during these two periods compared with the period before the MET?