Medical Response Team/ Pre-Code Team

I remember in my staffing year - a hundred years ago - having a patient who was clearly going to code. Although we paged him, we had no way of getting a resident up, let alone ICU, so we moved the bed into the middle of the room, took off the head and foot of the bed, brought in the crashcart, put on monitor leads, drew up drugs, and waited. My job was to wait, phone in hand, for her to actually code, then call switch. It was awful.

We instituted a MET (medical emergency team) response program about four years ago, to decrease ICU stays and improve patient outcomes. It's been very successful, and I think it's brilliant!

The criteria for calling a MET call is laid out, as follows:

Respiratory distress

Threatened airway

All respiratory arrests

Respiratory rate >30 or

Oxygen saturation

Difficulty speaking

All cardiac arrests

Systolic BP

Pulse rate > 130

Sudden drop in GCS (> 2 points)

Agitation or delirium

Repeated or prolonged seizures

Serious concern about patient[/u[

Unexpected post-procedural pain

Failure to respond to treatment

Unable to obtain assistance

There are signs about the criteria at every station, and all staff have a card attached to their ID badge which lists the criteria, too. A MET call can be initiated by any member of staff, which is great when we and the doctors disagree about how much assistance is needed.

It only works if the MET people are on board - initially we had a few calls for vasovagals and such, where they would arrive and say "Why were we called for this?" but that doesn't happen any more.

I remember one of the clinical coordinators saying that over 80% of arrests were on patients nurses had previously flagged as being of concern - our ICU bed stay has dropped, and our outcomes have absolutely improved. In addition, we now have clear treatment indications of many patients - far more of them are documented as Not For Resus, and we also know about whether or not they're for MET calls.