Medical emergency teams: deciphering clues to crises in hospitals

In 1994, Franklin and Mathew [1] recognized that cardiac arrests in hospitals are often preceded by prolonged physiologic deteriorations. These deteriorations not only presage patient deaths but they also offer an opportunity to recognize the crisis and trigger interventions that might be life saving. Since then, medical emergency team (MET) responses have been described by many authors, most notably several groups from Australia. Although there are no randomized clinical trials showing benefit from introduction of METs, many single center reports [2-4] support the notion that timely intervention may interrupt crisis events and decrease unexpected hospital mortality.As a result of these reports and of the potential for improved outcomes they offer, organizations such as the Institute for Healthcare Improvement and the Society for Critical Care Medicine have been promoting rapid response teams and METs. In North America and in Europe, there now appears to be a rapid increase in number of organizations that have implemented a MET program, following a trend set in Australia. The medical literature is now rapidly growing as well, but it has been focused almost exclusively on either the benefits of METs in terms of reducing unexpected mortality or on the processes impacted on by METs (e.g. improved detection of process errors) [5].What has not occurred is a characterization of the MET patient; for example, who is at risk, and what conditions and settings are dangerous? In other words, we do not understand the epidemiology of the MET patient. It is possible that there is a MET syndrome or syndromes. The syndrome(s) could be related to patient physiology during a dangerous time in their illness; perhaps each disease entity has an at-risk time for developing a medical crisis requiring a MET if no action is taken to prevent it. On the other hand, the MET patient may be instead a symptom of a hospital in crisis. In other words, the MET patient may be created by the environmen