title: Missed medical emergency team activations: tracking decisions and outcomes in practice.
abstract: BACKGROUND
  Despite extensive work to improve early recognition of and response to abnormal vital signs, a failure or delay in response to clinical deterioration by activating a medical emergency team (MET) can affect patient safety.
  
  
  OBJECTIVE
  To determine incidence, management and outcomes of patients having vital signs fulfilling MET call criteria during their entire admission, and to compare baseline characteristics and outcomes of patients who fulfilled MET call criteria with patients who did not.
  
  
  METHODS
  A retrospective chart audit was conducted in a private Melbourne hospital. All patients hospitalised for ≥ 24 hours in general wards and discharged in the 7-day study period were included. Medical records were reviewed for all patients who fulfilled MET criteria to assess escalation of care.
  
  
  RESULTS
  Of the sample (N = 568), 82 patients (14%) had one or more documented vital signs fulfilling MET criteria. Hospital length of stay (LOS) for these patients was twice that of those who did not (8.6 days versus 4.3 days; P < 0.001). Medical patients were more likely to meet MET criteria than surgical patients (P = 0.03), and there were no significant differences for sex or between elective and emergency admissions. In the 79 patients not reviewed by the MET, the primary nurse escalated care for 36 patients (46%). Nurses independently initiated treatment for 23 of these patients (64%) and when unable to, they referred the patient for medical review (36%). Presence of MET criteria had resolved within 1 hour for 37 patients (45%) who fulfilled criteria.
  
  
  CONCLUSIONS
  Despite one in seven patients fulfilling MET criteria, MET activation occurred infrequently. The presence of MET criteria was associated with a doubling of the hospital LOS. Escalation of care in response to detection of MET criteria fulfillment was variable. Further research tracking patient management is needed to understand the decision-making process that occurs in the presence of clinical deterioration.
authors.affiliation: Deakin University, Melbourne, VIC, Australia. j.guinane@deakin.edu.au.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Guinane
authors.forename: Tracey K
authors.initials: TK
authors.lastname: Bucknall
authors.forename: Judy
authors.initials: J
authors.lastname: Currey
authors.forename: Daryl A
authors.initials: DA
authors.lastname: Jones
mesh_terms: D000328:Adult; D003657:Decision Making; D004282:Documentation; D057209:Hospital Rapid Response Team / Q000458:organization & administration; D006801:Humans; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D055986:Vital Signs