title: Features and outcome of patients receiving multiple Medical Emergency Team reviews.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective observational study using prospectively collected data.
  
  
  METHODS
  Tertiary hospital.
  
  
  METHODS
  Cohort of 1664 patients receiving 2237 MET reviews over a 2-year period.
  
  
  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% C.I.: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia. paolo.calzavacca@austin.org.au
authors.forename: Paolo
authors.initials: P
authors.lastname: Calzavacca
authors.forename: Elisa
authors.initials: E
authors.lastname: Licari
authors.forename: Augustine
authors.initials: A
authors.lastname: Tee
authors.forename: Inga
authors.initials: I
authors.lastname: Mercer
authors.forename: Michael
authors.initials: M
authors.lastname: Haase
authors.forename: Anja
authors.initials: A
authors.lastname: Haase-Fielitz
authors.forename: Daryl
authors.initials: D
authors.lastname: Jones
authors.forename: Geoff
authors.initials: G
authors.lastname: Gutteridge
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D004638:Emergency Treatment / Q000592:standards*; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000458:organization & administration*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013577:Syndrome; D016896:Treatment Outcome; D055986:Vital Signs