A Medical Emergency Team (MET) consists of ICU physicians and nurses who respond to deteriorating patients on medical/surgical wards. The document discusses how a MET could help by identifying deteriorating patients earlier; reducing cardiac arrests and mortality; teaching ABCDE resuscitation to ward staff; and substituting for absent doctors. While there is no direct evidence that METs reduce mortality, Rapid Response Systems which include screening for deterioration and appropriate response have been shown to reduce cardiac arrests and in-hospital mortality according to several studies. The challenges for Rapid Response Systems are early detection of deterioration, timely triage, and ensuring patients are transferred to and receive care in the proper unit.

1. Medical Emergency Teams –
do they matter?
Andreas Hvarfner, MD, PhD
Perioperative Medicine and Intensive Care
Karolinska University Hospital, Stockholm
andreas.hvarfner@sll.se

2. • I declare no potential or actual conflicts of interest.

3. What is a Medical Emergency Team?
• ICU physician and ICU nurse
• 2 ICU nurses
• Other combinations of staff and equipment
• As compared to the previous model
• 1 ICU Physician

4. How may a MET matter?
• Identify the deteriorating patient earlier
• Reduce cardiac arrests, mortality and morbidity
• Assess and resuscitate a deteriorating patient in the ward
• Teach ABCDE to ward staff while assessing and resuscitating the deteriorating
patient
• Be service minded, “thank you for calling, how can I help you?”
• Identifying the dying patient and initiate limitations of medical measures and
initiating palliative care
• Substitute absent doctors at the wards, saving not only patients but also
abandoned nurses
• Deskill staff in the ward
• Staffing and economic resourses

5. Focus on reducing mortality
• Do MET reduce mortality/cardiac arrests as compared to no MET?
• I don’t know. There is no evidence.
• Do Rapid Response Systems reduce mortality/cardiac arrests?
• Yes, according to growing number of studies.

6. RRS effect on non-ICU adult cardiac arrests
”Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM. Rapid-response systems as a patient safety
strategy: a systematic review. Ann Intern Med. 2013;158:417–25

7. RRS effect on adult total in-hospital mortality
”Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM. Rapid-response systems as
a patient safety strategy: a systematic review. Ann Intern Med. 2013;158:417–25

8. What is a Rapid Response System?

9. The afferent limb
• Systems for identifying the deteriorating patient, EWS and similar
systems
• Monitoring availability
• Criteria regarding triage and transfer to higher level of care
• Staffing
• ABCDE competence and initial resusciation knowledge
• Are bed resourses/patient flows handled in an optimal way?

10. The efferent limb
• The Medical Emergency Team
• The Fire Brigade

11. How to prevent fire and deadly burns
• Building techniques and fireproof materials
• Emergency exits and information about emergency exits

12. When there is bad prevention
• The fire brigade will make a greater difference
• The Medical Emergency Team will make a greater difference

13. So, let’s hope that the prevention is good,
then the Medical Emergency Team will be
unnecessary

14. Rethinking Rapid Response Teams
E Litvak and P Pronovost, JAMA 2010;304:1375-
1376
• For the patients whose condition deteriorates while receiving
inadequate care in an improper unit, efforts should be made
to ensure that they receive adequate care in the proper unit,
• move away from taking credit for rescuing patients who
experience triage errors,
• focus on patient flow, and to provide each patient with the
right care at the right time, no more and not less.

15. The challenges for the Rapid Response
System
• Early detection of deterioration
• Triage in the right time
• Undramatic transfer of the patient to the proper unit
• Hospital-wide challenges not solwed by the MET