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Deteriorating Patients Managed with End-Of-Life Care Following Medical Emergency Team (MET) Calls.
Intern Med J. 2013 Dec 24;
Authors: Orosz J, Bailey M, Bohensky M, Gold M, Zalstein S, Pilcher D
Abstract
OBJECTIVE: To describe the characteristics of patients whose end-of-life care was initiated in response to a Medical Emergency Team (MET) call and to develop a predictive score to aid prospective identification of these patients.
DESIGN, SETTING: Retrospective cohort study of all MET calls in a tertiary teaching hospital between April 2010 and March 2011.
PARTICIPANTS: All inpatients attended by the hospital MET.
MAIN OUTCOME MEASURES: Patient demographics, admission features and comorbidities in active and palliative patients; timing, frequency, physiology and interventions in active and palliative MET calls.
RESULTS: 1567 MET calls were called for 1073 patients. 60 (5.6%) patients had at least one MET call resulting in initiation of end-of-life care. Palliative MET call patients compared to active patients were older (76.4 vs. 65.9 years; p<0.0001), had a shorter hospital stay (7.5 vs. 12 days; p=0.0002), increased in-hospital mortality (73.3% vs. 13.5%; p<0.001), higher Charlson comorbidity scores (3.1 vs. 2.1; p=0.0002) and were more likely to receive multiple MET calls (1.95/patient vs. 1.43/patient; p=0.011). Patient physiological parameters were worse at palliative MET calls. Prior history of malignancy, hemiplegia and peripheral vascular disease and increasing age were independently associated with initiation of end-of-life care and were used to derive a 13 point predictive score. Patients with a score of 7 or more had a 20% chance of having a Palliative MET call.
CONCLUSION: Prospective identification of patients requiring palliative care may be possible prior to MET involvement. This may allow more timely and appropriate end-of-life discussions.
PMID: 24373174 [PubMed - as supplied by publisher]