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Anthony Tzannes wrote 02-18-2011 06:01:54 am
The MET system has both advantages and disadvantages.

The key advantage is patient safety, a means of getting critical care skilled staff to the patient when an acute event occurs.

The disadvantages are already alluded to by Todd: deskilling of ward staff, high additional workload for ICUs with at times little benefit in terms of making decisions about any limitation of care before the patient deteriorates.

I work in WA where we are already under the pressures of the 4 hour rule. There has been a definite increase in MET calls (though analysis of data does not at this point definitely lay it all at the feet of the 4 hour rule according to admin) and ward staff have additional pressure placed on them to be in multiple places at once (ED admitting patients before the clock ticks over, wards to review sick patients, clinics etc.)

There are also National movements towards getting earlier appropriate review of deteriorating patients ie. pre MET. The key blocks to this noted in my hospital (a tertiary institution) have been getting medical staff to actually review the patient on the basis of changing Obs; and then getting an appropriate response.

Issues identified in terms of appropriate response include:
Consultant backing - at times difficult to get a total patient assessment and decision made when working within organ based specialties - easier to call a MET, plus at times issues with contacting consultants
Ward staff training and experience - within Australian system cri

Anthony Tzannes wrote 02-18-2011 06:02:43 am
Comment part II:


So what are the solutions? (Especially if 4 hour rule goes national into a hospital system designed on 8 hours a day, 5 days a week with cover the rest of the time)

1. Improve experience/skill set of ward staff by compulsory ICU and ED rotations with adequate senior staffing to ensure appropriate teaching. Has the advantages of finding positions for the increasing waves of new graduates and prevocational trainees while also guaranteeing positions for newly minted FCICMs etc. But can anyone see the Health Budget either expanding to accommodate this or being rearranged to employ more clinical staff?
2. Increase teaching of Ward Staff with courses such as the very BASIC course, again a funding and time off work issue
3. Improve ICU outreach programs with both access and teaching components. Would require lesser numbers of senior staff, but those involved would require a strong interest/skill set in teaching. Concept is to have staff available for ICU consults of unwell ward patients; however, the team would be required to be present while the review occurs and it would thus involve teaching about what was found and why decisions were made etc.
4. Change in behaviour/culture in tertiary hospitals from the House of God inspired buff and turf to stewardship of patients (instead of organs)

Todd Fraser wrote 07-19-2011 11:22:13 am
Neil has just added a review paper by Jones, DeVita and Bellomo reviewing the MET concept in the NEJM - definitely worth a read.

Anthony Tzannes wrote 02-23-2011 03:42:48 am
I feel that a combination of 2 and 3 with the culture shift of 4 is a potential approach to this issue. This will, however require a substantial commitment from hospital exec in terms of money and staff time.

The related issue that drives some of hospital culture is that of training requirements. If you are required to attend X outpatients clinics but there is no requirement to attend MET calls, where would be if there was a MET call on your patient during an outpatients clinic?

Any ideas would be appreciated, I have found myself on a hospital committee looking at this precise issue and seeing if the number of MET calls can be reduced by getting appropriate interventions happening before MET criteria are reached.

Todd Fraser wrote 10-07-2012 10:51:52 am
Daryl Jones and I had a chat about the MET system in a recent podcast - check it out here - http://crit-iq.com/index.php/podcast