MET service
SVHM, like most Australian hospitals, has a dedicated rapid response team that responds to medical emergencies occurring around the hospital. The team structure follows the framework set in the NSQHS Standard 9 in recognising and responding to clinical deterioration in acute health care.
The history:
The Medical Emergency Team (MET) was introduced at SVHM in 2003 as part of the MERIT Study [1], and continues to be in effect. At its inception, the team comprised a medical registrar, an ICU Registrar and an ICU Nurse. In 2005, a Critical Care Liaison Nurse (CCLN) service was set up and the CCLN became the ICU nursing team member. The CCLN now plays a pivotal role in:
Supporting the ward team in the management of complex and unwell patients outside the MET context
Facilitating communication with and transport to other parts of the hospital such as the Intensive Care Unit, Operating Theatres or Radiology.
MET system structure:
– Medical Emergency & Code Blue teams
– An Emergency Resuscitation Committee that meets regularly to review the operations of the rapid response teams
– Weekly review of all calls by Intensive Care Specialists with feedback and education where appropriate
– A MET database that stores data on all emergency calls.
3-monthly ward reports and 6-monthly activity reports were provided until 2017
– MET Education
Team members:
Medical Registrar, ICU Registrar, CCLN and Medical Resident. The primary treating team and bedside nurse also attend to form part of this team. Inpatient Code Blue responses add an Anaesthesia Registrar to the team.
Responses:
– MET response: response to clinical deterioration as triggered by criteria set using the Observation and Response Chart (ORC) parameters. Clinical concern outside the ORC parameters can also trigger a MET call.
– Code Blue Response (within clinical areas): This is a response to a cardio-respiratory arrest or threatened airway.
– Code Blue Response (outside clinical area): The Emergency Department responds to these calls.
Education:
In addition to attending clinical deterioration, the MET team provides education particularly to the junior staff. This includes dedicated MET study days that allow medical and nursing staff who participate in MET calls to learn a structured approached to teamwork, resuscitation and escalation of care for clinically deteriorating patients. Additionally, the CCLN provides ward staff with education and support around the care of patients of higher acuity who may have special requirements e.g tracheostomy care or non-invasive ventilation.
Research:
Opportunities arise for medical and nursing staff to participate in research activities both locally within the hospital, and within the greater critical care community under the direction of Safer Care Victoria.
References
Hillman K, Chen J, Cretikos M, et al. Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 2005;365:2091-7.