Ethan Rhodes
A MET call, or Medical Emergency Team call, is a hospital-based system designed to allow nurses or other staff members to call for help when a patient's vital signs fall outside a set range of criteria. The system was first designed at Liverpool Hospital in Sydney, Australia, in 1990 and has since spread throughout the Western world as part of a Rapid Response System. The MET call empowers nurses to exercise independent judgment and call for immediate assistance when a patient meets a predetermined set of clinical criteria.
| Characteristics | Values |
|---|---|
| Full Form | Medical Emergency Team |
| Designed At | Liverpool Hospital, Sydney, Australia |
| Designed In | 1990 |
| Caller | Nurse or other staff member |
| Purpose | Alerting other staff for help when a patient's vital signs are outside set criteria |
| Criteria | Studies suggesting that certain vital sign ranges and symptoms occur before poor patient conditions which may lead to death |
| Examples | Chest pain, raised heart rate, elevated blood pressure |
| Implementation | Phone call, emergency button on the wall, siren, flashing red light |
| Interventions and Tests | Oxygen (via a mask), Blood glucose levels, CPAP (Continuous positive airway pressure), X-ray, ECG, Vital signs, documentation, Spirometry |
| Staff Arrival | Two to three trained professionals |
| Post-MET | Some patients may be transferred to ICU |
| Success Factors | 'Political' support, detailed and repeated education, emphasis on hospital policy, increased collaboration between ICU and other units |
| Uptake | Progressive increase from 25 calls/month in 2000 to over 100/month in December 2005 at Austin Hospital |
| Nurse Survey Results | 84% felt it improved their work environment, 65% considered it a factor when seeking a new job |
| Challenges | Nurses may not always follow activation criteria, delays in calling associated with increased in-hospital mortality, doctors' discomfort over loss of control |
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What You'll Learn
MET call criteria
MET calls, or Medical Emergency Team calls, are triggered when a patient's vital signs fall outside set criteria. These criteria are based on studies suggesting that certain vital sign ranges and symptoms occur before a patient's condition worsens, which may lead to death. For example, chest pain, an elevated heart rate, and high blood pressure may indicate that a patient is about to have a heart attack.
The MET call system was designed at the Liverpool Hospital in Sydney, Australia, in 1990 and has since spread around the Western world as part of a Rapid Response System. The system empowers nurses or other staff members to alert and call for help when a patient's condition deteriorates. The call is generally made by phone or, in some cases, via an emergency button on the ward that sounds a siren and flashes a red light outside the patient's room.
The MET call criteria are widely used in hospitals to provide an early warning system to facilitate the escalation of care. The criteria are designed to identify patients who are at high risk or in the early phases of clinical deterioration. MET calls may be triggered using vital sign charts, where observations breach certain parameters that represent severe deterioration. Triggers may relate to single-parameter breaches, such as extremely low blood pressure, or a combination of less severe abnormal vital signs that are cumulatively scored to identify high-risk patients.
In some cases, MET activation criteria are modified to minimise unnecessary calls for patients with chronic physiological derangements or those who have recently received treatment for clinical deterioration. These modifications are made with the approval of senior doctors and aim to trigger METs at more extreme levels of physiological derangement. However, the safety implications of modifying MET activation criteria are not yet fully understood, and modifications have been associated with negative outcomes for patients.
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MET call activation
MET call (Medical Emergency Team) is a hospital-based system designed to help a patient whose vital signs have fallen outside a set criteria. The system was first introduced at the Liverpool Hospital in Sydney, Australia, in 1990 and has since spread around the Western world as part of a Rapid Response System.
The MET call is generally made by a phone call or via an emergency button on the ward, which sounds a siren. Most staff are encouraged to attend and help as required. Two to three trained professionals arrive at the room of the Emergency, along with doctors, nurses, and anyone else who is able to help. Jobs are allocated, including someone to record the nature of the emergency and what is being done to fix the problem.
Interventions and tests that the MET call may include: Oxygen (via a mask), blood glucose levels, CPAP (Continuous positive airway pressure), X-ray, ECG, vital signs, documentation, and Spirometry.
The MET system has been controversial because it implies extra work and represents a political change within the hospital hierarchy, empowering nurses on the ward to summon help from senior critical care medical staff. However, it has been found to reduce the workload of patients arriving in the ICU and increase collaboration between the ICU and other units.
The introduction of the MET service has changed the profile of the ICU within the hospital. ICU doctors and nurses are now seen in the hospital wards assessing and treating patients in the early phases of clinical deterioration. This has improved the interaction between the ICU and other departments, allowing them to work closely with the Clinical Governance Department to identify system problems in the management of unwell ward patients, assess these problems by root cause analysis, and develop strategies to prevent them.
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MET call interventions
MET calls (Medical Emergency Team) are a hospital-based system designed to provide early intervention and prevent serious adverse events, cardiac arrests, and unexpected deaths. When a patient's vital signs fall outside the set criteria, a MET call can be made by a nurse or other staff member to alert and call for help.
The MET call system was first introduced at the Liverpool Hospital in Sydney, Australia, in 1990 and has since spread throughout the Western world as part of a Rapid Response System. The implementation of the MET system represents a political change within the hospital hierarchy, empowering nurses on the ward to directly summon help from senior critical care medical staff, bypassing the traditional route of moving up the medical hierarchy.
- Oxygen administration via a mask
- Monitoring and managing blood glucose levels
- CPAP (Continuous Positive Airway Pressure)
- X-rays and ECGs (Electrocardiograms)
- Vital signs monitoring
- Documentation and spirometry
During a MET call, two to three trained professionals arrive at the patient's room and work together with staff to assist the patient. Jobs are allocated, including someone to record the nature of the emergency and the actions taken to address it. In some cases, patients may be transferred to the ICU following a MET call.
The introduction of the MET service has led to profound changes in the culture and medical practices within hospitals. It has improved the interaction between the ICU and other departments, allowing for better identification and management of 'at-risk' patients. Additionally, it has increased collaboration between the ICU and other units, emphasizing the importance of preventing critical illness within the hospital, not just treating it.
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MET call outcomes
MET (Medical Emergency Team) calls are designed to be made when a patient's vital signs have fallen outside of set criteria, indicating a potential emergency. The outcomes of a MET call can vary depending on the specific situation and the patient's condition. Here are some possible outcomes of a MET call:
Rapid Response and Intervention
The primary outcome of a MET call is the rapid response and intervention by the Medical Emergency Team. When a MET call is made, two to three trained professionals, including ICU medical and nursing staff, promptly arrive at the patient's room. They work together with the existing staff, including doctors and nurses, to assess and stabilise the patient. This may involve interventions such as administering oxygen, performing an ECG, checking blood glucose levels, or providing continuous positive airway pressure (CPAP). The team's expertise and timely response can help manage the patient's condition and prevent further deterioration.
Patient Stabilisation and Monitoring
The MET team's immediate priority is to stabilise the patient and ensure their vital signs return to acceptable levels. This may involve administering medications, providing respiratory support, or performing other necessary interventions. Once the patient is stabilised, the MET team and the patient's regular medical team will continue to monitor the patient closely to ensure their condition remains stable.
Transfer to Intensive Care Unit (ICU)
In some cases, the patient may require transfer to the Intensive Care Unit (ICU) for further monitoring and treatment. This is especially true for patients who have experienced a significant deterioration in their condition or are at a high risk of developing complications. The ICU provides specialised care and continuous monitoring to ensure the patient's condition is closely managed.
Root Cause Analysis and System Improvements
The activation of a MET call can trigger a root cause analysis and system improvements within the hospital. The MET service works closely with the Clinical Governance Department to identify system problems in the management of unwell patients. By analysing the outcomes of MET calls, hospitals can develop strategies to prevent future adverse events and improve patient care. This collaborative approach enhances the interaction between the ICU and other hospital departments, fostering a culture of continuous improvement.
Education and Training
MET calls can also highlight the need for ongoing education and training of hospital staff. Regular staff educational programs and audits of technology and processes are necessary to improve outcomes and the performance of the MET system. Hospitals may implement educational initiatives to ensure nursing and medical staff are familiar with the MET activation criteria and can recognise when a MET call is warranted.
Overall, the outcomes of a MET call can vary depending on the patient's condition and the specific circumstances of each case. The MET system aims to provide rapid response and intervention, stabilise patients, facilitate transfers to the ICU when necessary, drive system improvements, and promote education and training within the hospital setting.
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MET call controversy
The MET call (Medical Emergency Team) was designed at the Liverpool Hospital, Sydney, Australia, in 1990 and has since spread across the Western world as part of a Rapid Response System. It is a hospital-based system that allows nurses or other staff members to call for help when a patient's vital signs fall outside a set criteria, indicating severe deterioration.
The implementation of the MET system has been controversial. Firstly, it represents a political change within the hospital hierarchy, empowering nurses on the ward to directly summon help from senior critical care medical staff, bypassing the traditional route of moving up the medical hierarchy. This shift in power dynamics is not commonly discussed in scientific literature.
Secondly, while the MET system is intended to improve patient outcomes, its effectiveness has been debated. Early studies suggested an improvement in mortality from unexpected cardiac arrest with the availability of MET services. However, some later trials, like the MERIT study in 2005 and another by Howell et al. in 2012, found no significant impact on hospital mortality or incidence of cardiac arrest, despite increased resource utilisation. The inconclusive nature of these studies adds to the controversy surrounding the adoption of the MET system.
Additionally, the MET system has been criticised for its potential intrusion into patient privacy. The rapid response nature of MET calls may disrupt the doctor-patient relationship, as new medical personnel are introduced into the patient's care without an established relationship. Furthermore, sensitive patient information may be discussed aloud during the emergency response, potentially within earshot of bystanders, raising privacy concerns.
Despite the controversies, many institutions have adopted MET systems, recognising their potential to improve patient care and collaboration between ICU and other hospital units. However, the ongoing debates around the effectiveness, privacy implications, and hierarchical impact of MET calls highlight the need for further research and careful consideration of this complex issue.
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Frequently asked questions
MET stands for Medical Emergency Team.
A MET call is made when a patient's vital signs have fallen outside a set criteria. It is designed to be a rapid response system, allowing nurses to exercise independent judgement and call for immediate assistance.
A MET call is generally made by a phone call or via an emergency button on the wall, which sounds a siren. Most staff are encouraged to attend and help as required.
