Abstract
Purpose: Several studies have reported that the establishment of a medical emergency team (MET) decreases the mortality of in-hospital cardiopulmonary arrest patients. Our hospital set up an exclusive telephone line in the emergency room (ER) and intensive care unit (ICU) to enable them to call the MET, and this system has been in use since 2001. Acute care physicians must take turns to become a member of the team and lead the team, enabling performance of critical care at the bedside. The purpose of this study was to evaluate the activities of the MET and the effectiveness of calls, and to ascertain the necessary skills which MET members must acquire by identifying the emergency procedures performed.
Setting and Methods: The study was performed in a 1015-bed university hospital with approximately 20,000 admissions/year in Tokyo, Japan. We analyzed the number of request calls, source of the calls, patient diagnosis stated in the calls, interventions and procedures implemented by the MET, and training courses between April 2001 and March 2010.
Results: The number of in-hospital emergency request calls was about 40/year. Cases of cardiopulmonary arrest, hypotension, respiratory insufficiency, unconsciousness and convulsions comprised about 80% of all the calls. Cardiopulmonary resuscitation and airway management were performed in, and medication administered to, about 80% of patients. The MET performed cricothyroidotomy in 6 cases and defibrillation by an atrial external defibrillator in 12 cases. Cricothyroidotomy was performed more often in in-hospital patients than in patients who were transferred to the ER from the Department of Critical Care Medicine (Fisher's exact test, p<0.05). The survival discharge rate of cardiopulmonary arrest (CPA) cases was similar for cases occurring in the daytime or nighttime, and weekdays or holidays. Some emergency cases involved hospital staff of whom 3,000 attended cardiopulmonary resuscitation (CPR) + atrial external defibrillation (AED), and immediate cardiac life support (ICLS) training courses.
Conclusion: There were many serious cases that were treated by the MET, and there was a need for member physicians to learn how to perform cricothyroidotomy because emergency airway management is frequently necessary for admitted patients. The training courses facilitate the use of the MET system in the hospital, and shows that hospital staff are aware of, and are using, the MET system. Moreover, we also evaluated the reports of events and their feedback, in order to improve the capacity of this MET system for rapid response.
