An Evaluation of Medical Emergency Team Activation in Hospitalized Patients Designated as Not for Resuscitation

Abstract

The Medical Emergency Team (MET) responds to acute deterioration in hospitalized patients. The MET aims to reduce morbidity and mortality through early recognition and intervention in deteriorating patients. An adjunct role of the MET in limitations of medical therapy (LOMT) and end-of-life care (EOLC) has been reported in recent literature. LOMT frequently involve Not-for-Resuscitation (NFR) orders and patients who cannot be admitted to the Intensive Care Unit (ICU). Little is known of MET utilization in this population of patients. My objective was to report the incidence of MET activations in patients with LOMT and investigate their clinical and demographic characteristics, as well as outcomes. The two studies in this thesis are based on a retrospective cohort study of all adult in-patients with a MET activation at the University of Alberta Hospital from January 1, 2013, to December 31, 2015. There were a total of 2703 MET activations in 2218 patients during the study period. Patients with a LOMT were older, more likely to be admitted to a medical service, more likely to be female, had more comorbidities, and a longer MET call. These patients had a high in-hospital mortality rate of 58% compared to 23% in patients without a LOMT. In those who died, deaths occurred on average two days after index or last MET activation. A multivariable model showed an independent association between these patients GOC status and in-hospital mortality, OR: 3.49 (2.79 – 4.36 95% CI). A comparison of patients with a MET activation and NFR GOC status (GOC: M1 or below) who died and survived to hospital was performed. I found that patients who died in hospital were more likely to be male, have a greater burden of comorbidities, a MET activated for concerns over breathing, and a shorter hospital length of stay compared to those who survived to hospital discharge. This comparison revealed several areas requiring further research. In conclusion, the MET frequently responds to patients with LOMT who are NFR whose care would imply they not be admitted to the ICU. These patients have a high in-hospital mortality rate and die shortly after their MET activation, suggesting that they are near the end of life at the time of MET. MET policy should be revisited in an attempt to optimize resource utilization and quality of patient care.