Designing a more efficient, effective and safe Medical Emergency Team (MET) service using data analysis

<div><p>Introduction</p><p>Hospitals have seen a rise in Medical Emergency Team (MET) reviews. We hypothesised that the commonest MET calls result in similar treatments. Our aim was to design a pre-emptive management algorithm that allowed direct institution of treatment to patients without having to wait for attendance of the MET team and to model its potential impact on MET call incidence and patient outcomes.</p><p>Methods</p><p>Data was extracted for all MET calls from the hospital database. Association rule data mining techniques were used to identify the most common combinations of MET call causes, outcomes and therapies.</p><p>Results</p><p>There were 13,656 MET calls during the 34-month study period in 7936 patients. The most common MET call was for hypotension [31%, (2459/7936)]. These MET calls were strongly associated with the immediate administration of intra-venous fluid (70% [1714/2459] v 13% [739/5477] p<0.001), unless the patient was located on a respiratory ward (adjusted OR 0.41 [95%CI 0.25–0.67] p<0.001), had a cardiac cause for admission (adjusted OR 0.61 [95%CI 0.50–0.75] p<0.001) or was under the care of the heart failure team (adjusted OR 0.29 [95%CI 0.19–0.42] p<0.001).</p><p>Modelling the effect of a pre-emptive management algorithm for immediate fluid administration without MET activation on data from a test period of 24 months following the study period, suggested it would lead to a 68.7% (2541/3697) reduction in MET calls for hypotension and a 19.6% (2541/12938) reduction in total METs without adverse effects on patients.</p><p>Conclusion</p><p>Routinely collected data and analytic techniques can be used to develop a pre-emptive management algorithm to administer intravenous fluid therapy to a specific group of hypotensive patients without the need to initiate a MET call. This could both lead to earlier treatment for the patient and less total MET calls.</p></div

Comparison of interventions and outcomes of hypotensive patients who did receive intravenous fluid and were predicted to do so by the algorithm (‘true positives’), vs. those who did not receive intravenous fluid but would have been predicted to do so (‘false positives’), in the test period.

<p>‘True positives’ represent those with MET calls for SBP <90 mmHg, predicted to get intravenous fluid who did receive it. ‘False positives’ represent those with MET calls for SBP <90 mmHg, predicted to get intravenous fluid who did not receive it. The p values are for comparison between True and False positive cases. MET = Medical Emergency Team, ECG = Electrocardiogram, ABG = Arterial Blood Gas.</p

Modelled estimated effect of algorithm for immediate administration of intravenous fluid to patients with systolic blood pressure (SBP) < 90mmHg, on medical emergency team (MET) calls in the test period.

<p>Modelled estimated effect of algorithm for immediate administration of intravenous fluid to patients with systolic blood pressure (SBP) < 90mmHg, on medical emergency team (MET) calls in the test period.</p

Flow chart of the proposed algorithm.

<p>Flow chart of the proposed algorithm.</p

Comparison of patients who were given intravenous fluid therapy to those not given fluid therapy, at medical emergency team (MET) calls for hypotension, in the training period.

<p>Due to space constraints, for clinical units, MET call locations, and interventions, only results with (p < 0.05) are reported. mmol/L = Millimole per litre, micromol/L = micromoles per litre, g/dL = Grams per decilitre.</p

MET activations in the training period. Data includes only the first MET call per patient.

<p>MET = Medical Emergency Team, CPR = Cardiopulmonary resuscitation.</p

Comparisons of incidence in delay in relation to admitting units.

<p>Comparisons of incidence in delay in relation to admitting units.</p

Description of patient recruitment.

<p>Description of patient recruitment.</p

Characteristics at ICU discharge.

<p>Characteristics at ICU discharge.</p

Comparisons of duration of delay, reasons for delay and discharge decision revoked.

<p>Comparisons of duration of delay, reasons for delay and discharge decision revoked.</p