Dr. Andy

Reflections on medicine and biology among other things

Sunday, July 17, 2005

Medical Emergency Teams

This is such a good idea, I wish I had thought of it:
Much of the chaotic, terrifying and often unsuccessful drama of treating cardiac arrest in the hospital can be avoided, and the number of unexpected hospital deaths can be reduced by 30 percent, if a team of specially trained doctors and nurses steps in before the heart has stopped, as soon as the patient takes a turn for the worse.

That's the concept behind medical emergency teams, or MET
If you've never worked in a hospital, it might seem obvious that when a patient isn't doing well, he gets immediate attention, but too often that isn't the case. A patient starts doing poorly, so the nurse pages the intern. He is busy (covering 8 or 10 patients of his own, plus maybe 20 or 30 more if the other interns on the team have gone home) so it takes a while to make it to see the patient. Then he tries some (minor) intervention, hoping he won't have to bother the more senior resident and thereby admit he can't handle things himself. Another 30 to 60 minutes later he calls the resident, who is busy with an admission and takes 1/2 hour to get there. If everything goes well, the resident realizes the seriousness of the situation, starts appropriate interventions and calls the ICU, who sends another resident, or maybe fellow to try and block the transfer (ICUs are always full). If the patient is really sick, the ICU eventually agrees to take the patient, but it takes an hour to clear a bed, get nursing report, etc.

So 3 or 4 hours later at best, the patient makes it to the ICU where he starts getting the care he needs, but those 3 or 4 hours might be the difference between life and death (or between a minor setback and a major complication). With METs, the nurse can directly summon senior physician and nursing backup and manpower to intervene early in the process.


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