title: The effectiveness of implementation of the medical emergency team (MET) system and factors associated with use during the MERIT study.
abstract: OBJECTIVE
  The potential of the medical emergency team (MET) system to reduce adverse events may depend on the effectiveness of its implementation. We aimed to evaluate the effectiveness of the implementation of the MET system during the MERIT (Medical Early Response, Intervention and Therapy) study and to determine factors associated with the level of MET system utilisation.
  
  
  METHODS
  Surveys were conducted on the nursing staff from the general adult wards of all 12 MERIT study intervention hospitals after the 4-month implementation period and again after the 6-month study period. Hospital level variables were assessed for their correlation with MET utilisation. We measured awareness and understanding of the MET system, attendance at a MET education session, knowledge of the activation criteria, intention to call the MET, attitude to the MET system and the level of MET utilisation.
  
  
  RESULTS
  Across the 12 intervention hospitals, a median of 85.6% (interquartile range, 81.3%-88.8%) of MET activations were not related to a cardiac arrest or death. This measure of MET system utilisation varied significantly across the 12 hospitals (P = 0.002), and was significantly associated with knowledge of the activation criteria (P = 0.048), understanding of the purpose of the MET system (P = 0.01), perceptions of the hospital's readiness for a change in the way care was provided (P = 0.004), and an overall positive attitude to the MET system (P = 0.003).
  
  
  CONCLUSIONS
  Measures of the process of implementation of the MET system were significantly associated with the level of MET system utilisation.
authors.affiliation: The Simpson Centre for Health Services Research, and the University of New South Wales, Sydney, NSW, Australia. mcretikos@optusnet.com.au
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Cretikos
authors.forename: Jack
authors.initials: J
authors.lastname: Chen
authors.forename: Ken M
authors.initials: KM
authors.lastname: Hillman
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Simon R
authors.initials: SR
authors.lastname: Finfer
authors.forename: Arthas
authors.initials: A
authors.lastname: Flabouris
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D001364:Awareness; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009741:Nursing Staff, Hospital / Q000523:psychology*; D015397:Program Evaluation; D011795:Surveys and Questionnaires