Nature and characteristics of orthopaedic medical emergency team (MET) events: a retrospective study of 263 MET calls

Abstract

Background:Medical emergency teams (MET) are globally recognized strategies to improve outcomes of deteriorating patients. This study aimed to compare characteristics of hypotension and nonhypotension MET calls by characterizing triggers, timings, risk factors, management strategies, and outcomes of postoperative orthopaedic MET calls and provide information in identifying patients who require further perioperative assessment to facilitate better patient care. Methods:A retrospective, single-center review of postoperative orthopaedic MET calls between October 2017 and April 2019 was performed. MET calls were categorized into three groups depending on MET triggers and analyzed by preoperative, intraoperative, and postoperative parameters. Results:Comparing hypotension-only MET events (Group 1) with other triggers (Group 3), Group 1 showed patients who were younger (71.9 yr vs. 75.8 yr, P = 0.012), had elective procedures (52.0% vs. 37.1%, P = 0.032), and had non-neck of femoral fracture (71.0% vs. 53.0%, P = 0.007). They had fewer comorbidities (Charlson Comorbidity Index: 2.7 vs. 3.6, P = 0.011), fewer imaging investigations (12.0% vs. 50.8%, P < 0.05), larger volume fluid boluses (0.36L vs. 0.09L, P < 0.05), and fewer medication changes (27.0% vs. 43.2%, P = 0.013) or additions (18.0% vs. 56.8%, P < 0.05). Conclusions:Older age, emergency surgery, higher Charlson Comorbidity Index, preoperative delirium or dementia, and non-neck of femoral fracture orthopaedic patients were at higher risk of nonhypotension METs. In postoperative orthopaedic patients, hypotension-only METs were managed with an average crystalloid fluid bolus of 0.36L. Nonhypotension METs were more likely to be discharged to high level care nursing homes (HLCNH) and less likely to have an ICU admission. These findings have clinical implications for better patient identification and resource allocation of hospital systems.