Designing a more efficient, effective and safe Medical Emergency Team (MET) service using data analysis

Abstract

IntroductionHospitals have seen a rise in Medical Emergency Team (MET) reviews. We hypothesised that the commonest MET calls result in similar treatments. Our aim was to design a pre-emptive management algorithm that allowed direct institution of treatment to patients without having to wait for attendance of the MET team and to model its potential impact on MET call incidence and patient outcomes.MethodsData was extracted for all MET calls from the hospital database. Association rule data mining techniques were used to identify the most common combinations of MET call causes, outcomes and therapies.ResultsThere were 13,656 MET calls during the 34-month study period in 7936 patients. The most common MET call was for hypotension [31%, (2459/7936)]. These MET calls were strongly associated with the immediate administration of intra-venous fluid (70% [1714/2459] v 13% [739/5477] p<0.001), unless the patient was located on a respiratory ward (adjusted OR 0.41 [95%CI 0.25–0.67] p<0.001), had a cardiac cause for admission (adjusted OR 0.61 [95%CI 0.50–0.75] p<0.001) or was under the care of the heart failure team (adjusted OR 0.29 [95%CI 0.19–0.42] p<0.001).Modelling the effect of a pre-emptive management algorithm for immediate fluid administration without MET activation on data from a test period of 24 months following the study period, suggested it would lead to a 68.7% (2541/3697) reduction in MET calls for hypotension and a 19.6% (2541/12938) reduction in total METs without adverse effects on patients.ConclusionRoutinely collected data and analytic techniques can be used to develop a pre-emptive management algorithm to administer intravenous fluid therapy to a specific group of hypotensive patients without the need to initiate a MET call. This could both lead to earlier treatment for the patient and less total MET calls.

Characteristics and outcomes of rapid response team activations for hypotension in orthopaedic patients

“…This percentage is similar to data in non-orthopaedic patients, 31%, as described by Bergmeir et al 12 16,18,19 with mortality risk reported to be between 5 and 35%. 12,15,18 In our study, a hospital mortality of 8.5% possibly reflected the fact that most cases were due to hypovolaemia, which has been shown to be associated with a lower mortality. 15 Moreover, we analysed only the first RRT activation, and recurrent deterioration after initial stabilisation has been associated with increased mortality.…”

“…11 The differential diagnosis of postoperative hypotension and its subsequence treatment is challenging. Interestingly, 70% of such patients received an immediate bolus of fluid administration, 12 suggesting that pre-emptive fluid administration may prevent RRT calls. Interestingly, 70% of such patients received an immediate bolus of fluid administration, 12 suggesting that pre-emptive fluid administration may prevent RRT calls.…”

“…A single-centre study of 13 656 RRT calls in a heterogeneous surgical population demonstrated that 31% of calls were due to hypotension. Interestingly, 70% of such patients received an immediate bolus of fluid administration, 12 suggesting that pre-emptive fluid administration may prevent RRT calls. The applicability of such findings to patients undergoing orthopaedic surgery remains unknown.…”

Rapid response systems

“…For example, one group recently used routinely collected data from one hospital’s MET experiences to develop pre-emptive management algorithms for common deterioration triggers. 94 Further work in this area could allow some patients to receive initial interventions while rapid responders are en route to the bedside, or even with remote leadership via telemedicine. 95…”

Highlighting the rules between diagnosis types and laboratory diagnostic tests for patients of an emergency department: Use of association rule mining

“…Chan et al 31 investigated whether care-seeking patterns involve the use of healthcare services of various types prior to ED visits and examined the associations of these patterns with the severity of the presenting condition for ED visit and subsequent events. Bergmeir et al 32 aimed to design more efficient, effective, and safe medical emergency team service using ARM techniques.…”