Abstract
Discussion Forum (0)
ePoster
Topic: Rapid Response and Resuscitation
Tilak Ramesh, Nidhushie1; Chimunda, Timothy1,2,3,4,5
1. Bendigo Health Care Group, Bendigo, Australia
2. Goulburn Valley Health, Shepparton, Australia
3. Melbourne University, Melbourne, Australia
4. Queensland University, Brisbane, Australia
5. La Trobe University, Bendigo, Australia
Bendigo Health Care Group
INTRODUCTION:
The Medical Emergency Team (MET) is a hospital-wide service to prevent adverse clinical events via a team response to a breach of clinical criteria that identifies at-risk patients. (1) It provides a safety net for suddenly deteriorating patients with a mismatch of needs and resources. (2) MET systems are effective, however highly complex or inadequately implemented systems may reduce benefits. (3) There are many ways to evaluate MET systems including MET dosing, which is the number of MET activations per 1000 admissions. (2) Some hospitals have a MET review committee (MRC) which is a team of Intensive Care Unit (ICU) and general medical staff who meet regularly to review MET calls. They maintain a database of these events, and develop recommendations aimed at early recognition and appropriate timely response to clinical deterioration. (4) There are currently no studies which analyse the work of a MRC.
OBJECTIVES
To review utilisation of the MRC as a quality improvement tool and to report the nature of MET calls reviewed to describe quality factors that lead to increased reporting of MET calls for review.
Methods:
This review was undertaken in an Australian regional hospital over a 12-month period (1st Jan 2017 – 31st Dec 2017). MET calls were recorded by ICU staff on a paper form and then transcribed to an online MET database. Sentinel MET Call Reviews (SMCRs) were referred to the MRC based on clinical criteria breaches and reporter discretion (1). The MRC minutes were used to identify SMCRs. The MET database and associated logged Victorian Health Incident Management System reports were used to characterise and quantify the SMCRs. The biannual MET newsletter was used to identify the MET burden, MET dose and its impact on the cardiac arrest event rate. A root cause analysis tool was used to identify factors driving MET call issues. Descriptive summative qualitative statistics were used. Ethical approval was sought and granted.
Results
48 SMCRs were identified out of a recorded 2026 MET calls during the study period. The associated median annual (2017) MET dose was 124.5 MET call events per 1000 multiday admissions with a median cardiac arrest event rate of 1.3 per 1000 multiday admissions. The median age was 73 for males and 65.5 for females (p=0.218).
113 MET call issues were identified from the SMCRs. These were made of the following factors; clinician (36.3%), organisational (34.5%), patient (16.8%) and equipment (12.4%). The most common clinician factor was poor escalation planning documentation (56.1%). The most prevalent organisational factors were missed or delayed MET calls (30.8%) and delayed admission to ICU (28.2%). The only patient factor was multiple MET calls for a single patient. Mismatched patient monitoring was the most common equipment factor (57.1%).
The major SMCR diagnostic categories were cardiovascular (27.1%) and respiratory (22.9%). There was an average of 1.54 triggers per patient. Hypotension (31.1%) and tachycardia (16.2%) were the most common triggers. Septic shock, hypoxia and atrial fibrillation were the most represented clinical syndromes. 58.3% of SMCR patients stayed on the ward post MET call and 33.3% were admitted to ICU.
CONCLUSION
The approach of analysing SMCRs is a unique way to study MET calls and allowed for a quantitative thematic review. Clinician and organisation factors were the main drivers of SMCRs. There is clear need for education surrounding clinical escalation planning and its documentation.
Image 1
Image 2
Image 3
1. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET), Bendigo Hospital Protocol [Internet, last updated 2010 Feb 24, cited 2020 Jul 08].
2. Jones D, Bellomo R, DeVita M. Effectiveness of the Medical Emergency Team: the importance of dose. Critical Care [Internet]. 2009 Oct [cited 2020 Jul 08]; 13 (313). Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc7996
3. Chrysochoou G, Gunn S. Demonstrating the benefit of medical emergency teams (MET) proves more difficultthan anticipated. Critical Care [Internet]. 2006 Mar [cited 2020 Jul 01]; 10(2): 306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550880/#B2
4. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET) Review Group, Terms of Reference [Internet, last updated 2013 Nov 05, cited 2020 Jul 08].
Topic: Rapid Response and Resuscitation
Tilak Ramesh, Nidhushie1; Chimunda, Timothy1,2,3,4,5
1. Bendigo Health Care Group, Bendigo, Australia
2. Goulburn Valley Health, Shepparton, Australia
3. Melbourne University, Melbourne, Australia
4. Queensland University, Brisbane, Australia
5. La Trobe University, Bendigo, Australia
Bendigo Health Care Group
INTRODUCTION:
The Medical Emergency Team (MET) is a hospital-wide service to prevent adverse clinical events via a team response to a breach of clinical criteria that identifies at-risk patients. (1) It provides a safety net for suddenly deteriorating patients with a mismatch of needs and resources. (2) MET systems are effective, however highly complex or inadequately implemented systems may reduce benefits. (3) There are many ways to evaluate MET systems including MET dosing, which is the number of MET activations per 1000 admissions. (2) Some hospitals have a MET review committee (MRC) which is a team of Intensive Care Unit (ICU) and general medical staff who meet regularly to review MET calls. They maintain a database of these events, and develop recommendations aimed at early recognition and appropriate timely response to clinical deterioration. (4) There are currently no studies which analyse the work of a MRC.
OBJECTIVES
To review utilisation of the MRC as a quality improvement tool and to report the nature of MET calls reviewed to describe quality factors that lead to increased reporting of MET calls for review.
Methods:
This review was undertaken in an Australian regional hospital over a 12-month period (1st Jan 2017 – 31st Dec 2017). MET calls were recorded by ICU staff on a paper form and then transcribed to an online MET database. Sentinel MET Call Reviews (SMCRs) were referred to the MRC based on clinical criteria breaches and reporter discretion (1). The MRC minutes were used to identify SMCRs. The MET database and associated logged Victorian Health Incident Management System reports were used to characterise and quantify the SMCRs. The biannual MET newsletter was used to identify the MET burden, MET dose and its impact on the cardiac arrest event rate. A root cause analysis tool was used to identify factors driving MET call issues. Descriptive summative qualitative statistics were used. Ethical approval was sought and granted.
Results
48 SMCRs were identified out of a recorded 2026 MET calls during the study period. The associated median annual (2017) MET dose was 124.5 MET call events per 1000 multiday admissions with a median cardiac arrest event rate of 1.3 per 1000 multiday admissions. The median age was 73 for males and 65.5 for females (p=0.218).
113 MET call issues were identified from the SMCRs. These were made of the following factors; clinician (36.3%), organisational (34.5%), patient (16.8%) and equipment (12.4%). The most common clinician factor was poor escalation planning documentation (56.1%). The most prevalent organisational factors were missed or delayed MET calls (30.8%) and delayed admission to ICU (28.2%). The only patient factor was multiple MET calls for a single patient. Mismatched patient monitoring was the most common equipment factor (57.1%).
The major SMCR diagnostic categories were cardiovascular (27.1%) and respiratory (22.9%). There was an average of 1.54 triggers per patient. Hypotension (31.1%) and tachycardia (16.2%) were the most common triggers. Septic shock, hypoxia and atrial fibrillation were the most represented clinical syndromes. 58.3% of SMCR patients stayed on the ward post MET call and 33.3% were admitted to ICU.
CONCLUSION
The approach of analysing SMCRs is a unique way to study MET calls and allowed for a quantitative thematic review. Clinician and organisation factors were the main drivers of SMCRs. There is clear need for education surrounding clinical escalation planning and its documentation.
Image 1
Image 2
Image 3
1. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET), Bendigo Hospital Protocol [Internet, last updated 2010 Feb 24, cited 2020 Jul 08].
2. Jones D, Bellomo R, DeVita M. Effectiveness of the Medical Emergency Team: the importance of dose. Critical Care [Internet]. 2009 Oct [cited 2020 Jul 08]; 13 (313). Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc7996
3. Chrysochoou G, Gunn S. Demonstrating the benefit of medical emergency teams (MET) proves more difficultthan anticipated. Critical Care [Internet]. 2006 Mar [cited 2020 Jul 01]; 10(2): 306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550880/#B2
4. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET) Review Group, Terms of Reference [Internet, last updated 2013 Nov 05, cited 2020 Jul 08].
ePoster
Topic: Rapid Response and Resuscitation
Tilak Ramesh, Nidhushie1; Chimunda, Timothy1,2,3,4,5
1. Bendigo Health Care Group, Bendigo, Australia
2. Goulburn Valley Health, Shepparton, Australia
3. Melbourne University, Melbourne, Australia
4. Queensland University, Brisbane, Australia
5. La Trobe University, Bendigo, Australia
Bendigo Health Care Group
INTRODUCTION:
The Medical Emergency Team (MET) is a hospital-wide service to prevent adverse clinical events via a team response to a breach of clinical criteria that identifies at-risk patients. (1) It provides a safety net for suddenly deteriorating patients with a mismatch of needs and resources. (2) MET systems are effective, however highly complex or inadequately implemented systems may reduce benefits. (3) There are many ways to evaluate MET systems including MET dosing, which is the number of MET activations per 1000 admissions. (2) Some hospitals have a MET review committee (MRC) which is a team of Intensive Care Unit (ICU) and general medical staff who meet regularly to review MET calls. They maintain a database of these events, and develop recommendations aimed at early recognition and appropriate timely response to clinical deterioration. (4) There are currently no studies which analyse the work of a MRC.
OBJECTIVES
To review utilisation of the MRC as a quality improvement tool and to report the nature of MET calls reviewed to describe quality factors that lead to increased reporting of MET calls for review.
Methods:
This review was undertaken in an Australian regional hospital over a 12-month period (1st Jan 2017 – 31st Dec 2017). MET calls were recorded by ICU staff on a paper form and then transcribed to an online MET database. Sentinel MET Call Reviews (SMCRs) were referred to the MRC based on clinical criteria breaches and reporter discretion (1). The MRC minutes were used to identify SMCRs. The MET database and associated logged Victorian Health Incident Management System reports were used to characterise and quantify the SMCRs. The biannual MET newsletter was used to identify the MET burden, MET dose and its impact on the cardiac arrest event rate. A root cause analysis tool was used to identify factors driving MET call issues. Descriptive summative qualitative statistics were used. Ethical approval was sought and granted.
Results
48 SMCRs were identified out of a recorded 2026 MET calls during the study period. The associated median annual (2017) MET dose was 124.5 MET call events per 1000 multiday admissions with a median cardiac arrest event rate of 1.3 per 1000 multiday admissions. The median age was 73 for males and 65.5 for females (p=0.218).
113 MET call issues were identified from the SMCRs. These were made of the following factors; clinician (36.3%), organisational (34.5%), patient (16.8%) and equipment (12.4%). The most common clinician factor was poor escalation planning documentation (56.1%). The most prevalent organisational factors were missed or delayed MET calls (30.8%) and delayed admission to ICU (28.2%). The only patient factor was multiple MET calls for a single patient. Mismatched patient monitoring was the most common equipment factor (57.1%).
The major SMCR diagnostic categories were cardiovascular (27.1%) and respiratory (22.9%). There was an average of 1.54 triggers per patient. Hypotension (31.1%) and tachycardia (16.2%) were the most common triggers. Septic shock, hypoxia and atrial fibrillation were the most represented clinical syndromes. 58.3% of SMCR patients stayed on the ward post MET call and 33.3% were admitted to ICU.
CONCLUSION
The approach of analysing SMCRs is a unique way to study MET calls and allowed for a quantitative thematic review. Clinician and organisation factors were the main drivers of SMCRs. There is clear need for education surrounding clinical escalation planning and its documentation.
Image 1
Image 2
Image 3
1. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET), Bendigo Hospital Protocol [Internet, last updated 2010 Feb 24, cited 2020 Jul 08].
2. Jones D, Bellomo R, DeVita M. Effectiveness of the Medical Emergency Team: the importance of dose. Critical Care [Internet]. 2009 Oct [cited 2020 Jul 08]; 13 (313). Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc7996
3. Chrysochoou G, Gunn S. Demonstrating the benefit of medical emergency teams (MET) proves more difficultthan anticipated. Critical Care [Internet]. 2006 Mar [cited 2020 Jul 01]; 10(2): 306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550880/#B2
4. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET) Review Group, Terms of Reference [Internet, last updated 2013 Nov 05, cited 2020 Jul 08].
Topic: Rapid Response and Resuscitation
Tilak Ramesh, Nidhushie1; Chimunda, Timothy1,2,3,4,5
1. Bendigo Health Care Group, Bendigo, Australia
2. Goulburn Valley Health, Shepparton, Australia
3. Melbourne University, Melbourne, Australia
4. Queensland University, Brisbane, Australia
5. La Trobe University, Bendigo, Australia
Bendigo Health Care Group
INTRODUCTION:
The Medical Emergency Team (MET) is a hospital-wide service to prevent adverse clinical events via a team response to a breach of clinical criteria that identifies at-risk patients. (1) It provides a safety net for suddenly deteriorating patients with a mismatch of needs and resources. (2) MET systems are effective, however highly complex or inadequately implemented systems may reduce benefits. (3) There are many ways to evaluate MET systems including MET dosing, which is the number of MET activations per 1000 admissions. (2) Some hospitals have a MET review committee (MRC) which is a team of Intensive Care Unit (ICU) and general medical staff who meet regularly to review MET calls. They maintain a database of these events, and develop recommendations aimed at early recognition and appropriate timely response to clinical deterioration. (4) There are currently no studies which analyse the work of a MRC.
OBJECTIVES
To review utilisation of the MRC as a quality improvement tool and to report the nature of MET calls reviewed to describe quality factors that lead to increased reporting of MET calls for review.
Methods:
This review was undertaken in an Australian regional hospital over a 12-month period (1st Jan 2017 – 31st Dec 2017). MET calls were recorded by ICU staff on a paper form and then transcribed to an online MET database. Sentinel MET Call Reviews (SMCRs) were referred to the MRC based on clinical criteria breaches and reporter discretion (1). The MRC minutes were used to identify SMCRs. The MET database and associated logged Victorian Health Incident Management System reports were used to characterise and quantify the SMCRs. The biannual MET newsletter was used to identify the MET burden, MET dose and its impact on the cardiac arrest event rate. A root cause analysis tool was used to identify factors driving MET call issues. Descriptive summative qualitative statistics were used. Ethical approval was sought and granted.
Results
48 SMCRs were identified out of a recorded 2026 MET calls during the study period. The associated median annual (2017) MET dose was 124.5 MET call events per 1000 multiday admissions with a median cardiac arrest event rate of 1.3 per 1000 multiday admissions. The median age was 73 for males and 65.5 for females (p=0.218).
113 MET call issues were identified from the SMCRs. These were made of the following factors; clinician (36.3%), organisational (34.5%), patient (16.8%) and equipment (12.4%). The most common clinician factor was poor escalation planning documentation (56.1%). The most prevalent organisational factors were missed or delayed MET calls (30.8%) and delayed admission to ICU (28.2%). The only patient factor was multiple MET calls for a single patient. Mismatched patient monitoring was the most common equipment factor (57.1%).
The major SMCR diagnostic categories were cardiovascular (27.1%) and respiratory (22.9%). There was an average of 1.54 triggers per patient. Hypotension (31.1%) and tachycardia (16.2%) were the most common triggers. Septic shock, hypoxia and atrial fibrillation were the most represented clinical syndromes. 58.3% of SMCR patients stayed on the ward post MET call and 33.3% were admitted to ICU.
CONCLUSION
The approach of analysing SMCRs is a unique way to study MET calls and allowed for a quantitative thematic review. Clinician and organisation factors were the main drivers of SMCRs. There is clear need for education surrounding clinical escalation planning and its documentation.
Image 1
Image 2
Image 3
1. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET), Bendigo Hospital Protocol [Internet, last updated 2010 Feb 24, cited 2020 Jul 08].
2. Jones D, Bellomo R, DeVita M. Effectiveness of the Medical Emergency Team: the importance of dose. Critical Care [Internet]. 2009 Oct [cited 2020 Jul 08]; 13 (313). Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc7996
3. Chrysochoou G, Gunn S. Demonstrating the benefit of medical emergency teams (MET) proves more difficultthan anticipated. Critical Care [Internet]. 2006 Mar [cited 2020 Jul 01]; 10(2): 306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550880/#B2
4. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET) Review Group, Terms of Reference [Internet, last updated 2013 Nov 05, cited 2020 Jul 08].
Utility of a MET Call Review Committee as a Quality Improvement Tool to Identify Recurring MET Call Thematic Issues
Nidhushie Tilak Ramesh
Abstract
Discussion Forum (0)
ePoster
Topic: Rapid Response and Resuscitation
Tilak Ramesh, Nidhushie1; Chimunda, Timothy1,2,3,4,5
1. Bendigo Health Care Group, Bendigo, Australia
2. Goulburn Valley Health, Shepparton, Australia
3. Melbourne University, Melbourne, Australia
4. Queensland University, Brisbane, Australia
5. La Trobe University, Bendigo, Australia
Bendigo Health Care Group
INTRODUCTION:
The Medical Emergency Team (MET) is a hospital-wide service to prevent adverse clinical events via a team response to a breach of clinical criteria that identifies at-risk patients. (1) It provides a safety net for suddenly deteriorating patients with a mismatch of needs and resources. (2) MET systems are effective, however highly complex or inadequately implemented systems may reduce benefits. (3) There are many ways to evaluate MET systems including MET dosing, which is the number of MET activations per 1000 admissions. (2) Some hospitals have a MET review committee (MRC) which is a team of Intensive Care Unit (ICU) and general medical staff who meet regularly to review MET calls. They maintain a database of these events, and develop recommendations aimed at early recognition and appropriate timely response to clinical deterioration. (4) There are currently no studies which analyse the work of a MRC.
OBJECTIVES
To review utilisation of the MRC as a quality improvement tool and to report the nature of MET calls reviewed to describe quality factors that lead to increased reporting of MET calls for review.
Methods:
This review was undertaken in an Australian regional hospital over a 12-month period (1st Jan 2017 – 31st Dec 2017). MET calls were recorded by ICU staff on a paper form and then transcribed to an online MET database. Sentinel MET Call Reviews (SMCRs) were referred to the MRC based on clinical criteria breaches and reporter discretion (1). The MRC minutes were used to identify SMCRs. The MET database and associated logged Victorian Health Incident Management System reports were used to characterise and quantify the SMCRs. The biannual MET newsletter was used to identify the MET burden, MET dose and its impact on the cardiac arrest event rate. A root cause analysis tool was used to identify factors driving MET call issues. Descriptive summative qualitative statistics were used. Ethical approval was sought and granted.
Results
48 SMCRs were identified out of a recorded 2026 MET calls during the study period. The associated median annual (2017) MET dose was 124.5 MET call events per 1000 multiday admissions with a median cardiac arrest event rate of 1.3 per 1000 multiday admissions. The median age was 73 for males and 65.5 for females (p=0.218).
113 MET call issues were identified from the SMCRs. These were made of the following factors; clinician (36.3%), organisational (34.5%), patient (16.8%) and equipment (12.4%). The most common clinician factor was poor escalation planning documentation (56.1%). The most prevalent organisational factors were missed or delayed MET calls (30.8%) and delayed admission to ICU (28.2%). The only patient factor was multiple MET calls for a single patient. Mismatched patient monitoring was the most common equipment factor (57.1%).
The major SMCR diagnostic categories were cardiovascular (27.1%) and respiratory (22.9%). There was an average of 1.54 triggers per patient. Hypotension (31.1%) and tachycardia (16.2%) were the most common triggers. Septic shock, hypoxia and atrial fibrillation were the most represented clinical syndromes. 58.3% of SMCR patients stayed on the ward post MET call and 33.3% were admitted to ICU.
CONCLUSION
The approach of analysing SMCRs is a unique way to study MET calls and allowed for a quantitative thematic review. Clinician and organisation factors were the main drivers of SMCRs. There is clear need for education surrounding clinical escalation planning and its documentation.
Image 1
Image 2
Image 3
1. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET), Bendigo Hospital Protocol [Internet, last updated 2010 Feb 24, cited 2020 Jul 08].
2. Jones D, Bellomo R, DeVita M. Effectiveness of the Medical Emergency Team: the importance of dose. Critical Care [Internet]. 2009 Oct [cited 2020 Jul 08]; 13 (313). Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc7996
3. Chrysochoou G, Gunn S. Demonstrating the benefit of medical emergency teams (MET) proves more difficultthan anticipated. Critical Care [Internet]. 2006 Mar [cited 2020 Jul 01]; 10(2): 306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550880/#B2
4. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET) Review Group, Terms of Reference [Internet, last updated 2013 Nov 05, cited 2020 Jul 08].
Topic: Rapid Response and Resuscitation
Tilak Ramesh, Nidhushie1; Chimunda, Timothy1,2,3,4,5
1. Bendigo Health Care Group, Bendigo, Australia
2. Goulburn Valley Health, Shepparton, Australia
3. Melbourne University, Melbourne, Australia
4. Queensland University, Brisbane, Australia
5. La Trobe University, Bendigo, Australia
Bendigo Health Care Group
INTRODUCTION:
The Medical Emergency Team (MET) is a hospital-wide service to prevent adverse clinical events via a team response to a breach of clinical criteria that identifies at-risk patients. (1) It provides a safety net for suddenly deteriorating patients with a mismatch of needs and resources. (2) MET systems are effective, however highly complex or inadequately implemented systems may reduce benefits. (3) There are many ways to evaluate MET systems including MET dosing, which is the number of MET activations per 1000 admissions. (2) Some hospitals have a MET review committee (MRC) which is a team of Intensive Care Unit (ICU) and general medical staff who meet regularly to review MET calls. They maintain a database of these events, and develop recommendations aimed at early recognition and appropriate timely response to clinical deterioration. (4) There are currently no studies which analyse the work of a MRC.
OBJECTIVES
To review utilisation of the MRC as a quality improvement tool and to report the nature of MET calls reviewed to describe quality factors that lead to increased reporting of MET calls for review.
Methods:
This review was undertaken in an Australian regional hospital over a 12-month period (1st Jan 2017 – 31st Dec 2017). MET calls were recorded by ICU staff on a paper form and then transcribed to an online MET database. Sentinel MET Call Reviews (SMCRs) were referred to the MRC based on clinical criteria breaches and reporter discretion (1). The MRC minutes were used to identify SMCRs. The MET database and associated logged Victorian Health Incident Management System reports were used to characterise and quantify the SMCRs. The biannual MET newsletter was used to identify the MET burden, MET dose and its impact on the cardiac arrest event rate. A root cause analysis tool was used to identify factors driving MET call issues. Descriptive summative qualitative statistics were used. Ethical approval was sought and granted.
Results
48 SMCRs were identified out of a recorded 2026 MET calls during the study period. The associated median annual (2017) MET dose was 124.5 MET call events per 1000 multiday admissions with a median cardiac arrest event rate of 1.3 per 1000 multiday admissions. The median age was 73 for males and 65.5 for females (p=0.218).
113 MET call issues were identified from the SMCRs. These were made of the following factors; clinician (36.3%), organisational (34.5%), patient (16.8%) and equipment (12.4%). The most common clinician factor was poor escalation planning documentation (56.1%). The most prevalent organisational factors were missed or delayed MET calls (30.8%) and delayed admission to ICU (28.2%). The only patient factor was multiple MET calls for a single patient. Mismatched patient monitoring was the most common equipment factor (57.1%).
The major SMCR diagnostic categories were cardiovascular (27.1%) and respiratory (22.9%). There was an average of 1.54 triggers per patient. Hypotension (31.1%) and tachycardia (16.2%) were the most common triggers. Septic shock, hypoxia and atrial fibrillation were the most represented clinical syndromes. 58.3% of SMCR patients stayed on the ward post MET call and 33.3% were admitted to ICU.
CONCLUSION
The approach of analysing SMCRs is a unique way to study MET calls and allowed for a quantitative thematic review. Clinician and organisation factors were the main drivers of SMCRs. There is clear need for education surrounding clinical escalation planning and its documentation.
Image 1
Image 2
Image 3
1. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET), Bendigo Hospital Protocol [Internet, last updated 2010 Feb 24, cited 2020 Jul 08].
2. Jones D, Bellomo R, DeVita M. Effectiveness of the Medical Emergency Team: the importance of dose. Critical Care [Internet]. 2009 Oct [cited 2020 Jul 08]; 13 (313). Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc7996
3. Chrysochoou G, Gunn S. Demonstrating the benefit of medical emergency teams (MET) proves more difficultthan anticipated. Critical Care [Internet]. 2006 Mar [cited 2020 Jul 01]; 10(2): 306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550880/#B2
4. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET) Review Group, Terms of Reference [Internet, last updated 2013 Nov 05, cited 2020 Jul 08].
ePoster
Topic: Rapid Response and Resuscitation
Tilak Ramesh, Nidhushie1; Chimunda, Timothy1,2,3,4,5
1. Bendigo Health Care Group, Bendigo, Australia
2. Goulburn Valley Health, Shepparton, Australia
3. Melbourne University, Melbourne, Australia
4. Queensland University, Brisbane, Australia
5. La Trobe University, Bendigo, Australia
Bendigo Health Care Group
INTRODUCTION:
The Medical Emergency Team (MET) is a hospital-wide service to prevent adverse clinical events via a team response to a breach of clinical criteria that identifies at-risk patients. (1) It provides a safety net for suddenly deteriorating patients with a mismatch of needs and resources. (2) MET systems are effective, however highly complex or inadequately implemented systems may reduce benefits. (3) There are many ways to evaluate MET systems including MET dosing, which is the number of MET activations per 1000 admissions. (2) Some hospitals have a MET review committee (MRC) which is a team of Intensive Care Unit (ICU) and general medical staff who meet regularly to review MET calls. They maintain a database of these events, and develop recommendations aimed at early recognition and appropriate timely response to clinical deterioration. (4) There are currently no studies which analyse the work of a MRC.
OBJECTIVES
To review utilisation of the MRC as a quality improvement tool and to report the nature of MET calls reviewed to describe quality factors that lead to increased reporting of MET calls for review.
Methods:
This review was undertaken in an Australian regional hospital over a 12-month period (1st Jan 2017 – 31st Dec 2017). MET calls were recorded by ICU staff on a paper form and then transcribed to an online MET database. Sentinel MET Call Reviews (SMCRs) were referred to the MRC based on clinical criteria breaches and reporter discretion (1). The MRC minutes were used to identify SMCRs. The MET database and associated logged Victorian Health Incident Management System reports were used to characterise and quantify the SMCRs. The biannual MET newsletter was used to identify the MET burden, MET dose and its impact on the cardiac arrest event rate. A root cause analysis tool was used to identify factors driving MET call issues. Descriptive summative qualitative statistics were used. Ethical approval was sought and granted.
Results
48 SMCRs were identified out of a recorded 2026 MET calls during the study period. The associated median annual (2017) MET dose was 124.5 MET call events per 1000 multiday admissions with a median cardiac arrest event rate of 1.3 per 1000 multiday admissions. The median age was 73 for males and 65.5 for females (p=0.218).
113 MET call issues were identified from the SMCRs. These were made of the following factors; clinician (36.3%), organisational (34.5%), patient (16.8%) and equipment (12.4%). The most common clinician factor was poor escalation planning documentation (56.1%). The most prevalent organisational factors were missed or delayed MET calls (30.8%) and delayed admission to ICU (28.2%). The only patient factor was multiple MET calls for a single patient. Mismatched patient monitoring was the most common equipment factor (57.1%).
The major SMCR diagnostic categories were cardiovascular (27.1%) and respiratory (22.9%). There was an average of 1.54 triggers per patient. Hypotension (31.1%) and tachycardia (16.2%) were the most common triggers. Septic shock, hypoxia and atrial fibrillation were the most represented clinical syndromes. 58.3% of SMCR patients stayed on the ward post MET call and 33.3% were admitted to ICU.
CONCLUSION
The approach of analysing SMCRs is a unique way to study MET calls and allowed for a quantitative thematic review. Clinician and organisation factors were the main drivers of SMCRs. There is clear need for education surrounding clinical escalation planning and its documentation.
Image 1
Image 2
Image 3
1. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET), Bendigo Hospital Protocol [Internet, last updated 2010 Feb 24, cited 2020 Jul 08].
2. Jones D, Bellomo R, DeVita M. Effectiveness of the Medical Emergency Team: the importance of dose. Critical Care [Internet]. 2009 Oct [cited 2020 Jul 08]; 13 (313). Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc7996
3. Chrysochoou G, Gunn S. Demonstrating the benefit of medical emergency teams (MET) proves more difficultthan anticipated. Critical Care [Internet]. 2006 Mar [cited 2020 Jul 01]; 10(2): 306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550880/#B2
4. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET) Review Group, Terms of Reference [Internet, last updated 2013 Nov 05, cited 2020 Jul 08].
Topic: Rapid Response and Resuscitation
Tilak Ramesh, Nidhushie1; Chimunda, Timothy1,2,3,4,5
1. Bendigo Health Care Group, Bendigo, Australia
2. Goulburn Valley Health, Shepparton, Australia
3. Melbourne University, Melbourne, Australia
4. Queensland University, Brisbane, Australia
5. La Trobe University, Bendigo, Australia
Bendigo Health Care Group
INTRODUCTION:
The Medical Emergency Team (MET) is a hospital-wide service to prevent adverse clinical events via a team response to a breach of clinical criteria that identifies at-risk patients. (1) It provides a safety net for suddenly deteriorating patients with a mismatch of needs and resources. (2) MET systems are effective, however highly complex or inadequately implemented systems may reduce benefits. (3) There are many ways to evaluate MET systems including MET dosing, which is the number of MET activations per 1000 admissions. (2) Some hospitals have a MET review committee (MRC) which is a team of Intensive Care Unit (ICU) and general medical staff who meet regularly to review MET calls. They maintain a database of these events, and develop recommendations aimed at early recognition and appropriate timely response to clinical deterioration. (4) There are currently no studies which analyse the work of a MRC.
OBJECTIVES
To review utilisation of the MRC as a quality improvement tool and to report the nature of MET calls reviewed to describe quality factors that lead to increased reporting of MET calls for review.
Methods:
This review was undertaken in an Australian regional hospital over a 12-month period (1st Jan 2017 – 31st Dec 2017). MET calls were recorded by ICU staff on a paper form and then transcribed to an online MET database. Sentinel MET Call Reviews (SMCRs) were referred to the MRC based on clinical criteria breaches and reporter discretion (1). The MRC minutes were used to identify SMCRs. The MET database and associated logged Victorian Health Incident Management System reports were used to characterise and quantify the SMCRs. The biannual MET newsletter was used to identify the MET burden, MET dose and its impact on the cardiac arrest event rate. A root cause analysis tool was used to identify factors driving MET call issues. Descriptive summative qualitative statistics were used. Ethical approval was sought and granted.
Results
48 SMCRs were identified out of a recorded 2026 MET calls during the study period. The associated median annual (2017) MET dose was 124.5 MET call events per 1000 multiday admissions with a median cardiac arrest event rate of 1.3 per 1000 multiday admissions. The median age was 73 for males and 65.5 for females (p=0.218).
113 MET call issues were identified from the SMCRs. These were made of the following factors; clinician (36.3%), organisational (34.5%), patient (16.8%) and equipment (12.4%). The most common clinician factor was poor escalation planning documentation (56.1%). The most prevalent organisational factors were missed or delayed MET calls (30.8%) and delayed admission to ICU (28.2%). The only patient factor was multiple MET calls for a single patient. Mismatched patient monitoring was the most common equipment factor (57.1%).
The major SMCR diagnostic categories were cardiovascular (27.1%) and respiratory (22.9%). There was an average of 1.54 triggers per patient. Hypotension (31.1%) and tachycardia (16.2%) were the most common triggers. Septic shock, hypoxia and atrial fibrillation were the most represented clinical syndromes. 58.3% of SMCR patients stayed on the ward post MET call and 33.3% were admitted to ICU.
CONCLUSION
The approach of analysing SMCRs is a unique way to study MET calls and allowed for a quantitative thematic review. Clinician and organisation factors were the main drivers of SMCRs. There is clear need for education surrounding clinical escalation planning and its documentation.
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1. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET), Bendigo Hospital Protocol [Internet, last updated 2010 Feb 24, cited 2020 Jul 08].
2. Jones D, Bellomo R, DeVita M. Effectiveness of the Medical Emergency Team: the importance of dose. Critical Care [Internet]. 2009 Oct [cited 2020 Jul 08]; 13 (313). Available from: https://ccforum.biomedcentral.com/articles/10.1186/cc7996
3. Chrysochoou G, Gunn S. Demonstrating the benefit of medical emergency teams (MET) proves more difficultthan anticipated. Critical Care [Internet]. 2006 Mar [cited 2020 Jul 01]; 10(2): 306. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1550880/#B2
4. Bendigo Health, Bendigo, Australia, Medical Emergency Team (MET) Review Group, Terms of Reference [Internet, last updated 2013 Nov 05, cited 2020 Jul 08].
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