title: Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial.
abstract: BACKGROUND
  Patients with cardiac arrests or who die in general wards have often received delayed or inadequate care. We investigated whether the medical emergency team (MET) system could reduce the incidence of cardiac arrests, unplanned admissions to intensive care units (ICU), and deaths.
  
  
  METHODS
  We randomised 23 hospitals in Australia to continue functioning as usual (n=11) or to introduce a MET system (n=12). The primary outcome was the composite of cardiac arrest, unexpected death, or unplanned ICU admission during the 6-month study period after MET activation. Analysis was by intention to treat.
  
  
  RESULTS
  Introduction of the MET increased the overall calling incidence for an emergency team (3.1 vs 8.7 per 1000 admissions, p=0.0001). The MET was called to 30% of patients who fulfilled the calling criteria and who were subsequently admitted to the ICU. During the study, we recorded similar incidence of the composite primary outcome in the control and MET hospitals (5.86 vs 5.31 per 1000 admissions, p=0.640), as well as of the individual secondary outcomes (cardiac arrests, 1.64 vs 1.31, p=0.736; unplanned ICU admissions, 4.68 vs 4.19, p=0.599; and unexpected deaths, 1.18 vs 1.06, p=0.752). A reduction in the rate of cardiac arrests (p=0.003) and unexpected deaths (p=0.01) was seen from baseline to the study period for both groups combined.
  
  
  CONCLUSIONS
  The MET system greatly increases emergency team calling, but does not substantially affect the incidence of cardiac arrest, unplanned ICU admissions, or unexpected death.
authors.forename: Ken
authors.initials: K
authors.lastname: Hillman
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.forename: Michelle
authors.initials: M
authors.lastname: Cretikos
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Daniel
authors.initials: D
authors.lastname: Brown
authors.forename: Gordon
authors.initials: G
authors.lastname: Doig
authors.forename: Simon
authors.initials: S
authors.lastname: Finfer
authors.forename: Arthas
authors.initials: A
authors.lastname: Flabouris
mesh_terms: D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team