Features and outcome of patients receiving multiple Medical Emergency Team reviews

Background and objectives: There is no information on the clinical features and outcome of patients receiving multiple Medical Emergency Team (MET) reviews. Accordingly, we studied the characteristics and outcome of patients receiving one MET call and compared them with those receiving multiple MET reviews. Design: Retrospective observational study using prospectively collected data. Setting: Tertiary hospital. Patients: Cohort of 1664 patients receiving 2237 MET reviews over a 2-year period. Measurements and main results: We retrieved information about patient demographics, reasons for MET review, procedures performed by the MET and hospital outcome. We found that 1290 (77.5%) patients received a single MET review and 374(22.5%) received multiple MET reviews (mean 2.5 reviews, median 2.0). Multiple MET reviews were more likely to be in surgical patients (p < 0.001) and to be due to arrhythmias (p = 0.016). Multiple MET review patients were more likely to be admitted for gastrointestinal diseases (p < 0.001), had a 50% longer hospital stay (p < 0.001) and a 34.6% increase in hospital mortality (p < 0.001) compared to single MET review patients. Their odds ratio (OR) for mortality was 2.14 (95% Cl.: 1.62-2.83; p < 0.001). After exclusion of patients with not for resuscitation (NFR) orders, the OR for mortality was 2.92 (95% C.I.: 2.10-4.06; p < 0.001). The in-hospital mortality of patients subject to multiple MET reviews who were not designated NFR was 34.1%, but only 9.7% of these deaths occurred within 48 h of the initial MET review. Conclusion: In our hospital, one fifth of patients receiving MET calls are subject to multiple MET calls. Such patients have identifiable features and have an increased risk of morbidity and mortality. Within any rapid response system, such patients should be recognized as a higher risk group and receive specific additional attention. (c) 2010 Elsevier Ireland Ltd. All rights reserved.