Improving the documentation of medical emergency team reviews

To improve the documentation of events surrounding medical emergency team (MET) calls and to audit the incidence of MET calls and subsequent patient outcomes.

Prospective audit and patient chart review before and after three simultaneous interventions: medical team education, addition of intensive care personnel to the MET and introduction of a dedicated medical documentation pro forma. Data collected included patient demographics (including outcomes), features of each MET call (criteria, timing and treatment) and the completeness of medical documentation using nine predetermined criteria. Baseline data were collected over 5 months, April to August 2005. Following a 2-week education period, data were collected for a further 4 months, September to December 2005. Apart from the principal investigators, medical and nursing staff were not aware of this research during either data collection period.

There were 94 MET calls (10.3 per 1000 admissions) during the baseline period and 101 (14.2 per 1000 admissions) after the interventions. MET calls were more common in medical than surgical patients (34.9 v 12.9 calls per 1000 admissions; P < 0.001). Sixty of the 195 calls (30.7%) resulted in patients being transferred to a critical care area, and the overall in-hospital mortality following a MET call was 31.8%. The interventions resulted in a significant increase in the overall quantity and quality of medical documentation (in seven out of the nine criteria). The interventions were not associated with an increase in hospital resource utilisation, in particular hospital bed days or admissions to critical care areas.

Critical-care resource utilisation and inhospital mortality risk following a MET call at our institution is high. Three simple interventions improved the quality of medical documentation but did not significantly increase overall resource utilisation or improve patient outcomes.