An analysis of Medical Emergency Team (MET) activated events and goals of care trajectories across the General Medical In-patient journey

Abstract

Background/Aims: We aimed to evaluate the characteristics, predictors for, and outcomes of Medical Emergency Team (MET) activated events, and identify associations with Goals of Care (GOC) changes across the General Medical admission. Methods: A 12-month retrospective observational study was conducted at Royal Melbourne Hospital (January-December-2021), comparing General Medical admissions requiring METs versus those not. Results: 423 (9.2%) of 4594 identified admissions required METs; MET patients had higher Charlson comorbidity index (CCI) score (2 vs 1), ICU admission (19.4% vs 5.5%), and length of stay (16.6 vs 5.8 days). MET patients were associated with increased inpatient mortality (9.9% vs 1.6%), more conservative GOC at admission end (45.4% vs 35.5% GOC C/D), and only 44.4% (vs 70.9%) were discharged to independent living. The most significant independent predictor for METs was higher CCI score: Score 1-2; OR 1.63 (p=0.01), Score >=3; OR 3.61 (p=<0.001). Increasing age (by decade) was associated with reduced METs (OR 0.89, p=0.01). Higher CCI score was also associated with increased in-patient mortality: Score 1-2; OR 5.51 (p=0.01), Score >=3; OR 15.35 (p=<0.001). The occurrence of a MET (OR 0.25, p=<0.001), higher CCI score (CCI>=3; OR 0.44, p=<0.001), and advancing age (>=90 years; OR 0.24, p=<0.001) were independently associated with increased conservative GOC at admission end. Conclusion: General Medical inpatients requiring METs had higher co-morbidities, length of stay and inpatient mortality, with less likelihood of discharge to independent living. Increasing CCI score was an independent predictor for METs, in-patient mortality, and a change towards more conservative GOC at admission end.