Nurses’ perceptions of accessing a Medical Emergency Team: A qualitative study

doi:10.1016/j.aucc.2013.11.001

Australian Critical Care

Volume 27, Issue 3, August 2014, Pages 133-138

https://doi.org/10.1016/j.aucc.2013.11.001 Get rights and content

Abstract

Background

Medical Emergency Teams (METs) have been developed and implemented with the aim of improving recognition of and response to deteriorating patients. Yet, METs are often not activated or used effectively by nursing staff. The reasons for this are not fully understood.

Objectives

The aim of this study was to explore nurses’ experiences and perceptions of using and activating a MET, in order to understand the facilitators and barriers to nurse's use of the MET.

Design, setting and participants

An interpretive qualitative approach was adopted to explore nurses’ experiences and perceptions of using and activating the MET. This study was set in a large public teaching hospital in Southeast Queensland, Australia. Fifteen registered ward nurses who had cared for patients who had deteriorated on the ward, and as a result of this deterioration were admitted to the Intensive Care Unit (ICU) as an unplanned admission, were interviewed about their experiences and perceptions of using a MET.

Methods

In-depth, semi-structured interviews were conducted with ward nurses who had cared for a patient who had deteriorated. Interviews were recorded and transcribed verbatim. The interviews were analysed thematically.

Findings

Four themes relating to the participants’ experiences and perceptions of using a MET emerged from the data. These themes were: (1) sensing clinical deterioration; (2) resisting and hesitating; (3) pushing the button; and (4) support and leadership.

Conclusion

This work identifies why nurses do not activate METs appropriately. This delay in MET activation potentially exposes the deteriorating patient to suboptimal care and increases the risk of adverse events.

Section snippets

Background

The past decade has seen increasing focus on recognising and responding to the deteriorating hospitalised patient.1, 2, 3 Much of this interest has been prompted by findings that have demonstrated patient deterioration is often not recognised or responded to in a timely manner.4, 5, 6 Failure to recognise and respond to patient deterioration and to escalate care has led to an increased risk of adverse events in hospitalised patients that may have been avoided had appropriate care been

Study aims

The aim of this study was to explore nurse's experiences and perceptions of accessing a MET in an Australian hospital. We also aimed to understand what facilitated nurse's use of a MET and what nurses identified as the barriers to using a MET.

Methods

An interpretive qualitative approach was adopted to explore nurses’ experiences and perceptions of using a MET. Qualitative research is inductive, rather than testing pre-determined hypotheses19, 20 allowing for an in-depth understanding of the experiences and meanings that individuals attach to a phenomenon.²⁰

Leadership and support

Leadership and support were acknowledged as important factors in supporting or hindering MET activation. The participants highlighted the identification of a leader as important because it ensured that activation of the MET was less stressful and less disjointed. By promoting a more organised approach to managing the deteriorating patient, participants identified that they were more likely to activate a MET in future. Tanya stated:

“I think if a clear leader is designated to manage and lead the

Discussion

Four themes relating to the participants’ experiences and perceptions of using a MET emerged from the data: (1) sensing clinical deterioration; (2) resisting and hesitating; (3) pushing the button; and (4) leadership and support. The findings of this study suggest that participants used information gained from patient assessment to recognise and respond to patient deterioration. Nurses discussed how they perceived the MET activation criteria useful in identifying and sensing clinical

Strengths and limitations

In this study a detailed exploration of a complex clinical phenomenon, the deteriorating patient within the context of the MET, was undertaken. This has resulted in a better understanding of how nurses recognise and respond to the deteriorating patient and use, or do not use METs. This is a sensitive clinical issue that impacts on, patient outcomes, quality of care and healthcare resources. Accessing and exploring the experiences and perceptions of frontline staff within the clinical

Recommendations

Despite its limitations, this study has contributed to the body of knowledge of nurse's experiences and perceptions of activating and using METs and recognising and responding to the deteriorating patient. The nurses interviewed in this case study identified that they were frequently reluctant to use the METs. This suggests that further interventions need to be undertaken to help nurses change their behaviour in relation to activating a MET. However, behavioural change is perhaps one of the

Conclusion

In conclusion, recognising, and managing the deteriorating patient is complex, challenging, and multifaceted. Patient acuity will continue to increase in hospitals as the inpatient population becomes older and sicker with more complex clinical care needs. METs have been embraced as part of the patient safety agenda by leaders and organisations both nationally and internationally, and appear to be here to stay. There are, however, challenges in relation to how METs are integrated, adopted, and

Authors’ contributions

Debbie Massey, Wendy Chaboyer and Leanne Aitken conceptualised and designed the study. Collection of data was done by Debbie Massey. Analysis of data was done by Debbie Massey, Wendy Chaboyer and Leanne Aitken. They also drafted and revised the article and gave final approval of the version to be submitted.

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Citation Excerpt :
Failure to activate MET in these instances is deemed MET afferent limb failure often without taking into account specific patient circumstances and nuances of care or the National Consensus Statements (essential elements for recognising and responding to acute physiological deterioration) range of responses to deteriorating patients including increasing frequency of assessment, managing deterioration at a local level within nursing and medical scope of practice and resources through to activating specialist teams such as MET, and transferring patients to a higher level of care.15 Escalation of care directly to medical staff instead of activating the MET occurred in three patients and may be indicative of nurses' preferring to escalate care via the patient's home team over calling the MET, which has also been documented in other studies.17,23 It is also possible that nurses prefer to communicate their concerns to ward medical staff with whom they have a relationship over MET responders who they may not know or are making deliberate decisions that escalation of care to ward medical staff who know the patient is better than calling responders from the ICU with limited patient-specific knowledge.31,32
Medical emergency team (MET) afferent limb failure is the presence of MET triggers and the absence of a documented MET call.
The aim of this study was to measure and understand the frequency and nature of MET afferent limb failure in patients with documented vital sign abnormalities in an Australian major teaching hospital.
A retrospective point prevalence study was conducted at a 600-bed teaching hospital in Melbourne, Australia. Data were collected for all adult inpatients (aged ≥18 years) on 13 wards (three general medicine, three surgical, and seven specialist wards) during a randomly selected 24-h period. Data were extracted from the electronic medical record.
There were 357 patients included in the study, with a median age of 72 y. Of the 9716 vital sign measures extracted, 0.9% fulfilled patient-specific MET activation criteria. There were 93 MET triggers documented in 36 patients: 25 patients experienced MET afferent limb failure. The major issues related to MET afferent limb failure were MET trigger modification processes, resolution of vital sign abnormalities, alternative escalation of care, and limitations of medical treatment orders without specific modifications to MET triggers.
Mandating MET activation for one aberrant vital sign at a single point in time warrants further assessment: lack of timely vital sign resolution may be a more appropriate trigger for MET calls and should be formally tested in future research. The frequency and effectiveness of alternative escalation pathways and local management of patients with MET triggers also warrant further investigation.
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View full text

Nurses’ perceptions of accessing a Medical Emergency Team: A qualitative study

Abstract

Background

Objectives

Design, setting and participants

Methods

Findings

Conclusion

Section snippets

Background

Study aims

Methods

Leadership and support

Discussion

Strengths and limitations

Recommendations

Conclusion

Authors’ contributions

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Resuscitation

Intensive Critical Care Nursing

Acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital. Clinical guideline 50

Rapid response teams: reducing codes and raising morale

Developing strategies to prevent in hospital cardiac arrest: analysing responses of physicians and nurses in the hours before the event

Critical Care Medicine

Unexpected deaths and referrals to intensive care of patients on general wards. Are some cases potentially avoidable?

Journal Royal College Physicians London

Confidential inquiry into quality of care before admission to intensive care

British Medical Journal

An acute problem? A report of the National Confidential Enquiry into Patient Outcome and Death

Findings of the first consensus conference on medical emergency teams

Critical Care Medicine

Adverse events in British hospitals: preliminary retrospective record review

BMJ

The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada

Candian Medical Association Journal

Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study 1991

Quality Safety in Health Care

An analysis of the causes of adverse events from the Quality in Australian Health Care Study

Medical Journal Australia

Rapid response systems: should we still question their implementation?

Journal of Hospital Medicine

Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial

The Lancet