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.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1. Lee A, Bishop G, Hillman K, Daffum K. The Medical Emergency Team. Anaesth Intensive Care 1995; 23: 183-186.
- 2. McQuillan P, Pilkington S, Allan A, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ 1998; 316: 1853-1858.
- 3. Smith GB, Nolan J. Medical emergency teams and cardiac arrests in hospital. BMJ 2002; 324: 1215.
- 4. O'Dea J, Pepperman M, Bion J. Comprehensive Critical Care: a national strategic framework in all but name. Intensive Care Med 2003; 29: 341.
- 5. Bellomo R, Goldsmith D, Uchino S, et al. A prospective before-and-after trial of a medical emergency team. Med J Aust 2003; 179: 283-287. <MJA full text>
- 6. Deane SA, Gaudry PL, Pearson I, et al. Implementation of a trauma team. Aust N Z J Surg 1989; 59: 373-378.
- 7. Buist M, Moore GE, Bernard SA, et al. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ 2002; 324: 387-390.
- 8. Petticrew M. Why certain systematic reviews reach uncertain conclusions. BMJ 2003; 326: 756-758.
- 9. Sackett DL, Rosenberg WMC, Gray JAM, et al. Evidence based medicine: what it is and what it isn't. BMJ 1996; 312: 71-72.
- 10. Worrall J. What evidence in evidence-based medicine? Philos Sci 2002; 69: 316-331.
- 11. Bandolier. Evidence based thinking about health care. How systematic reviews can disappoint. Available at: www.jr2.ox.ac.uk/bandolier/band93/b93-6.html (accessed May 2003).
- 12. Rapid responses to: Buist M et al. BMJ 2002; 324: 387-390. Available at: bmj.com/cgi/eletters/324/7334/387 (accessed Jul 2003).
- 13. Ellis J, Mulligan I, Rowe J, Sackett DL. Inpatient general medicine is evidence-based. Lancet 1995; 346: 407-410.
- 14. Kerridge I, Lowe M, Henry D. Ethics and evidence based medicine. BMJ 1998; 316: 1151-1153.
- 15. Leeder SR, Rychetnik L. Ethics and evidence-based medicine. Med J Aust 2001; 175: 161-164.
- 16. Little M. “Better than numbers . . .” A gentle critique of evidence-based medicine. Aust N Z J Surg 2003; 73: 177-182.
- 17. Wooldridge M, quoted by Downey M. “Trust me I'm a doctor”. Sydney Morning Herald 1997; 10 May: 1.
- 18. Manns BJ, Lee H, Doig CJ, et al. An economic evaluation of activated protein C treatment for severe sepsis. N Engl J Med 2002; 347: 993-1000.
- 19. Chalfin DB, Teres D, Rapoport J. A price for cost-effectiveness: implications for recombinant human activated protein C (rhAPC). Crit Care Med 2003; 31: 306-308.
- 20. Eichacker PQ, Natanson C. Recombinant human activated protein C in sepsis: inconsistent trial results, an unclear mechanism of action, and safety concerns resulted in labeling restrictions and the need for phase IV trials. Crit Care Med 2003; 31 (1 Suppl): S94-S96.
- 21. Spiegel BM, Targownik L, Dulai GS, Gralnek IM. The cost-effectiveness of cyclooxygenase-2 selective inhibitors in the management of chronic arthritis. Ann Intern Med 2003; 138: 795-806.
- 22. Marra CA, Esdaile JM, Sun H, Anis AH. The cost of COX inhibitors: how selective should we be? J Rheumatol 2000; 27: 2731-2733.
The John Hunter Hospital is a participant in the MERIT study.