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Associations between patient and system characteristics and MET review within 48 h of admission to a teaching hospital: A retrospective cohort study

  • Joshua Allen
    Correspondence
    Corresponding author.
    Affiliations
    Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Geelong, VIC 3220, Australia
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  • Liliana Orellana
    Affiliations
    Deakin University, Biostatistics Unit, Faculty of Health, Geelong, VIC 3220, Australia
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  • Daryl Jones
    Affiliations
    DEPM Monash University, Level 6 The Alfred Centre (Alfred Hospital), 99 Commercial Road, Melbourne, Victoria 3004, Australia

    Department of Surgery University of Melbourne, Austin Hospital, Studley Road Heidelberg, Victoria 3084, Australia

    Intensive Care Unit, Austin Hospital, Studley Road Heidelberg, Victoria 3084, Australia
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  • Julie Considine
    Affiliations
    Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Geelong, VIC 3220, Australia

    Centre for Quality and Patient Safety Research – Eastern Health Partnership, 2/5 Arnold Street, Box Hill, VIC 3128, Australia
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  • Judy Currey
    Affiliations
    Deakin University, Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Geelong, VIC 3220, Australia
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      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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