title: Physiological antecedents and ward clinician responses before medical emergency team activation.
abstract: OBJECTIVE
  To investigate the frequency, characteristics and timing of objectively measured clinical instability in adult ward patients in the 24 hours preceding activation of the medical emergency team (MET). We also examined ward clinician responses to documented clinical instability.
  
  
  METHODS
  A descriptive, exploratory design with a retrospective medical record audit. We descriptively analysed data from 200 ward patients reviewed by the MET at a tertiary teaching hospital in Melbourne, Australia, during 2014.
  
  
  METHODS
  Frequency and characteristics of urgent clinical review (UCR) criteria breaches in the 24 hours preceding MET activation, and in-hospital mortality.
  
  
  RESULTS
  Overall, 78.5% of patients breached UCR criteria at least once in the 24 hours preceding MET activation, with 80.9% having multiple breaches. The most common causes of UCR criteria breaches were hypoxaemia without supplemental oxygen (27.4%, n = 43) and hypoxaemia with supplemental oxygen (21.7%, n = 34) for first UCR criteria breaches, and tachycardia (33.1%, n = 42) for last UCR criteria breaches during the 24 hours we examined. The median time before MET activation for first and last breaches was 17.1 hours and 1.2 hours, respectively. Examination of the clinician documentation suggested a high incidence of pre-MET activation afferent limb failure. In-hospital mortality was 12%.
  
  
  CONCLUSIONS
  Patients commonly and repeatedly breached objectively measured UCR criteria in the 24 hours preceding MET activation, providing numerous opportunities for clinicians to recognise and respond to early clinical deterioration. The high incidence of pre- MET afferent limb failure requires further exploration.
authors.affiliation: School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia. s.sprogis@deakin.edu.au.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Sprogis
authors.affiliation: School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.
authors.forename: Judy
authors.initials: J
authors.lastname: Currey
authors.affiliation: School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Considine
authors.affiliation: School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Baldwin
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
authors.forename: Daryl
authors.initials: D
authors.lastname: Jones
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D057209:Hospital Rapid Response Team / Q000592:standards; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013997:Time Factors