Highlights
- •At admission, patient diagnosis, comorbidities are associated with later MET review.
- •Charlson Score 1–2 or ≥ 3; 3+ prior emergency admissions; are important risk factors.
- •MET risk double in admissions for colorectal, respiratory, upper GI or infection.
- •Health system factors including time or season of admission associated with MET.
- •Associations similar for MET within 48 or 72 h of admission.
Abstract
The Medical Emergency Team (MET) has enhanced the recognition and response to clinical
deterioration in acute healthcare. However, patients reviewed by the MET are at increased
risk of in-hospital death. Identifying patients at risk of deterioration may improve
patient outcomes.
Aim
To identify patient demographic, medical characteristics and healthcare systems and
processes at the time of admission (baseline), associated with Medical Emergency Team
(MET) review within 48 h (MET-48 h) of admission.
Methods
Single-site, year-long, retrospective cohort comprising patients admitted for at least
24 h, using routinely collected hospital data. A three-stage modelling approach was
used to identify baseline factors associated with MET-48 h
Results
The study included 15,695 patients with mean age 62.1 years (SD 19.6), male (53.5%),
born in Australia or New Zealand (60.9%) and 51.6% held a low-income concession card.
A total of 4.3% of patients received a MET review within 48 h of admission. Variables
independently associated with MET-48 h in a fully adjusted logistic model included
age of 80 years or more (OR = 1.37); ≥3 previous emergency admissions (OR = 1.59);
Charlson Comorbidity Index 1 or 2 (OR = 1.47), or ≥ 3 (OR = 1.99); history of alcohol-related
behaviour concerns (OR = 2.04), chronic heart failure (OR = 1.48); chronic obstructive
pulmonary disease (OR = 1.35); admission for colorectal (OR = 2.66) or upper gastro-intestinal
(OR = 1.94) surgery, respiratory or tracheostomy (OR = 2.24); immunology and infections
(OR = 1.90); emergency admission (OR = 1.36); admission at night (OR = 1.74), or summer
(OR = 1.41)
Conclusions
This is the first study to demonstrate the potential to predict clinical deterioration
using data that is readily accessible at the time of admission to hospital.
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Article info
Publication history
Published online: May 30, 2019
Accepted:
May 20,
2019
Received in revised form:
March 21,
2019
Received:
January 14,
2019
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
