Abstract 13: Prospective Implementation of Medical Emergency Team on a Cardiothoracic Unit
Background: Medical emergency or rapid response teams (MET) may reduce the need for in-hospital resuscitation, and improve hospitalized patient outcomes. METs have become commonplace and are emerging on regulatory agendas. Controlled, prospective studies of MET have, however, provided conflicting data on effectiveness. There have only been two published studies of MET in the U.S. We implemented a prospective MET on a cardiothoracic unit in August, 2005.
Methods: An interdisciplinary clinical team established MET policies and procedures. The response team composition included an ICU RN, respiratory therapist, and most senior available MD. A six-week pre-implementation training period was instituted for the nursing staff. Immediately post implementation, an immersive simulation workshop with video feedback was provided to nurses on the target unit. Baseline cardiac arrest data for the target unit pre-implementation over the past two years was 1.2 per month.
Results: 53 MET calls occurred over 640 days, approximately 3/month. Mean response time = 6 minutes, mean duration of MET call care = 34 minutes, 53% of patients required ICU transfer, over 90% of patients experiencing a MET call survived to discharge. 7% of patients had a cardiopulmonary arrest at some point during their hospital stay post-MET call. Cardiac arrests on the pilot unit decreased and remained 63% below controls over 640 days. Confounding factors which might have influenced MET results included new hospital-wide surgical resident night float and quality improvement initiatives. Cardiac arrests in the rest of the hospital units did not change. Qualitative analysis of MET debriefings revealed chains of events of patient deterioration managed effectively with the MET framework for teamwork, resource utilization, and systems management.
Conclusions: We present a longstanding MET intervention in a unique setting - a cardiothoracic hospital unit embedded in a tertiary care hospital which has not yet instituted organization-wide MET. Despite widespread systems changes, only the MET unit had sustained drop in cardiac arrests. Staff and patient satisfaction for the MET was high. Immersive simulation training with video feedback may have significant potential for augmenting MET impact.