Exploring Patient deterioration: a 5.5 year audit of Medical Emergency Team calls in a rural Australian hospital.

Dr Joanne Porter1, Ms Anita Raymond1, Dr Karen Missen1
1Federation University Australia, Trafalgar, Australia

Aim: The aim of this paper is to report on the incidence of MET call Activations in a single regional hospital over a 5 year period.
Methods: A retrospective observational study of the hospital’s electronic risk management system between 2011 and 2016, was conducted. All 1,674 MET cases recorded during the period were included.
Results: MET activation per 1,000 hospital inpatient admissions increased from approximately 7.3/1,000 in 2011-2012, to 13.7/1,000 in 2014-15. This increase coincided with the introduction in June 2014 of more standardized patient observation charts. The Acute Deterioration Detection System charts enabled visual ratings of each vital sign and actions that were taken dependent on the total score. Thereafter, MET demand decreased by 17% in the next year, 2014-2015. Unplanned admissions to the ICU/CCU unit increased significantly, from a mean 16% in 2011-2014, to a mean of 38.5% in 2015-2016. MET calls showed significant diurnal rhythms; 66% occurred during daylight hours 0600 hrs to 1800 hrs, and 11.8% between midnight and 0600 hrs (p=<0.05). Despite some variation in demand over days of the week, no statistically significant difference was identified over the whole period. Low BP <90, Low GCS and Worried category remained the primary reasons for MET activation throughout.
Conclusion: The introduction of the adult deterioration detection system charts had an effect on the overall number of MET calls, with ‘hypotension’, ‘low Glasgow Coma Scores’ and ‘Worried’ being recorded as the primary activation reasons. Further research is recommended to develop an understanding of the ‘Worried’ activation category and the frequency in which vital signs are recorded on all patients in particular those that are deteriorating.

Dr Joanne Porter currently works at the School of Nursing, Midwifery and Healthcare at Federation University Australia, Gippsland campus. Teaching into the undergraduate program, and postgraduate higher Degree supervision. She has worked both in Metropolitan and regional health facilities predominantly in Emergency departments and Intensive care units. Her research interests include, deteriorating patient outcomes, simulation, and emergency care research. Her PhD through Monash University used a mixed methods approach to investigate the affect family presence during resuscitation (FPDR) had on personnel in the emergency department. Joanne currently holds the position of Senior lecturer and has an extensive research history with a number of publications and competitive grants.