The medical emergency team, evidence-based medicine and ethics

The medical emergency team (MET), which may be summoned by anyone in a hospital to treat a patient who appears acutely unwell, has been generally accepted as scientifically rational, with no adverse clinical outcomes and only modest resource requirements. Despite this, many centres appear to be awaiting “gold standard” evidence of its effectiveness. We suggest that the quest for evidence is providing scientific justification for institutional inertia, and that further delay in implementing this system may even be unethical. We propose that decisions about changes in healthcare should consider scientific rationality, clinical reasonableness and resource implications, as well as evidence and ethical implications.

A medical emergency team (MET)1 can be simply described as a cardiac arrest team with changed calling criteria. Anyone in a hospital may summon the team to a patient who appears acutely unwell, even if the patient has not actually had a cardiac arrest. The introduction of a MET may be accompanied by education on better recognition of acute illness, and an ongoing audit and education process. There is an implied and unquantified increase in the workload of the intensive care unit (ICU) staff, and a need for them to shift the focus of their work (at least temporarily) outside ICU.