Medical Emergency Team (MET) Procedure
****Background: Despite Mayday Team expertise, survival after arrest in the hospital remains unchanged since approximately 1970. Multiple studies (including a review of our own patients at Berkshire Medical Center) has shown that 40-70% of patients have documented signs of clinical instability prior to arrest. Preliminary data from multiple centers has shown that early identification and response to signs of clinical instability can prevent subsequent clinical decompensation.
Purpose:
· Identify patients with signs of clinical instability.
· Maintain a team with expertise in evaluating and treating patients with serious illness.
· Mobilize that team any time a patient is deemed “unstable” (see below under accessing MET services)
· Stabilize the patient and arrange for proper disposition prior to further clinical decompensation.
Membership:
· ICU/CCU charge nurse
· Primary nurse
· Senior Medical Resident (as assigned by the Chief Medical Resident)
o Weekdays: Medical Consult or Ward Senior as per Chief Medical Resident assignment..
o Nights: Night Float Senior Medical Resident
o Weekend days: Medical Admitting Resident (as assigned by Chief Medical Resident)
· Respiratory Therapist
Accessing MET services: Any healthcare team member caring for any patient who meets defined criteria should activate the MET team by calling the operator or using the BHS paging system.
o Chest pain
o Threatened airway
o RR<5 or >36
o Pulse rate <40 or >140
o SBP <90
o Hypoxemia (< 90%)
o Repeated or prolonged seizures
o Altered mental status
o Acute significant bleed
o Failure to respond to treatment
o Stroke symptoms *
o “Worried” hospital staff
MET Resident responsibility:
o Work with team to stabilize patient
o Assure appropriate disposition
o Notify: attending physician, family, and housestaff team caring for patient of any changes in the patient status.
o MET resident may delegate responsibilities to the floor team covering the patient but the ultimate responsibility is theirs unless floor team accepts.
o Complete documentation of conditions, interventions taken, assessment and plan and file in the patients chart.
****Medical Emergency Teams have not yet been shown by randomized control trials to definitively improve outcomes. Therefore a critical component of our MET program is to collect data, analyze outcomes and reassess the value of this program. Between 2000 (year initiated) and 2005 BMC data have shown considerable benefit ascribable to this team, with the rate of in hospital cardiac arrest decreasing from greater than 2.5 to less than 1.5 arrests per 1000 discharges.