Objective: To determine the rate of adverse events and incidents occurring as a result of hospital staff leaving normal duties to attend medical emergency team (MET) calls.
Design, participants and setting: Single-centre, interview and questionnaire-based study of staff attending MET calls at a 650-bed university teaching hospital in Sydney, New South Wales, July to December 2013.
Main outcome measure: The rate of adverse events and incidents directly related to MET staff leaving normal duties to attend MET calls.
Results: During the study period, 1490 structured interviews were conducted, and 279 written questionnaires were returned (overall response rate, 66.4%). There were no adverse events. There were 378 recorded incidents. The incident rate was 213.7 incidents per 1000 MET participant attendances (95% CI, 194.8–233.5), and 1.1 incidents per MET call. Using the severity assessment code, 99.5% of incidents were classified as minimum. The most commonly reported incidents were disruptions to normal duties, ward rounds, and patient reviews. Only 0.8% of incidents were reported on institutional incident reporting systems.
Conclusion: Significant disruption to normal hospital routines and inconvenience to staff occurred, without causing major harm to patients, when MET staff temporarily left normal duties to attend MET calls. Normal hospital incident reporting systems cannot be used to monitor for these problems, as they are underreported.
- 1. Lee A, Bishop G, Hillman KM, Daffurn K. The medical emergency team. Anaesth Intensive Care 1995; 23: 183-186.
- 2. Berwick DM, Calkins DR, McCannon CJ, Hackbarth AD. The 100000 lives campaign: setting a goal and a deadline for improving health care quality. JAMA 2006; 295: 324-327.
- 3. Goldhill DR, Worthington L, Mulcahy A, et al. The patient-at-risk team: identifying and managing seriously ill ward patients. Anaesthesia 1999; 54: 853-860.
- 4. Garcea G, Thomasset S, McClelland L, et al. Impact of a critical care outreach team on critical care readmissions and mortality. Acta Anaesthesiol Scand 2004; 48: 1096-1100.
- 5. Jones DA, DeVita MA, Bellomo R. Rapid-response teams. N Engl J Med 2011; 365: 139-146.
- 6. Cheung W, Mann-Farrar J, Gullick J, et al. Future trials to investigate a ward physician leadership model for the Medical Emergency Team are not logistically feasible. Anaesth Intensive Care 2013; 41: 679-680.
- 7. NSW Health Clinical Excellence Commission. Between the Flags: keeping patients safe. http://www.health.nsw.gov.au/initiatives/btf/index.asp (accessed Apr 2014).
- 8. NSW Health. Recognition and management of patients who are clinically deteriorating. Policy directive PD2013_049. 2013. http://www0.health.nsw.gov.au/policies/pd/2013/PD2013_049.html (accessed Apr 2014).
- 9. National Health and Medical Research Council. NHMRC glossary. http://www.nhmrc.gov.au/book/glossary (accessed Apr 2014).
- 10. ClinicalTrials.gov. “Basic Results” data element definitions. Draft. http://prsinfo.clinicaltrials.gov/results_definitions.html (accessed Apr 2014).
- 11. ClinicalTrials.gov. Glossary of common site terms. http://www.clinicaltrials.gov/ct2/about-studies/glossary (accessed Apr 2014).
- 12. NSW Health. Incident management policy. Policy directive PD2007_061. Sydney: NSW Health, July 2007.
- 13. American Association for Public Opinion Research. Standard definitions: final dispositions of case codes and outcome rates for surveys. 7th ed. 2011. http://aapor.org/Content/NavigationMenu/AboutAAPOR/StandardsampEthics/StandardDefinitions/StandardDefinitions2011.pdf (accessed Jun 2014).
- 14. Cheung W, Gullick J, Thanakrishnan G, et al. Injuries occurring in hospital staff attending medical emergency team (MET) calls — a prospective, observational study. Resuscitation 2009; 80: 1351-1356.
- 15. Hillman K, Chen J, Cretikos M, et al; MERIT study investigators. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 2005; 365: 2091-2097.
- 16. Vetro J, Natarajan DK, Mercer I, et al. Antecedents to cardiac arrests in a hospital equipped with a medical emergency team. Crit Care Resusc 2011; 13: 162-166.
- 17. Jones D, Bellomo R, DeVita MA. Effectiveness of the Medical Emergency Team: the importance of dose. Crit Care 2009; 13: 313.
- 18. Santiano N, Young L, Hillman K, et al. Analysis of medical emergency team calls comparing subjective to “objective” call criteria. Resuscitation 2009; 80: 44-49.
- 19. Casamento AJ, Dunlop C, Jones DA, Duke G. Improving the documentation of medical emergency team reviews. Crit Care Resusc 2008; 10: 29.
- 20. Jones D, Bates S, Warrillow S, et al. Effect of an education programme on the utilization of a medical emergency team in a teaching hospital. Intern Med J 2006; 36: 231-236.
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