by Cindy Abole
Public Relations
Imagine it’s fourth down and the ball is within kicking distance of the field goal. The coach assesses the situation and calls for the team’s specialty group—the team’s field goal kicker and unit, to do their job at the right time during the game.
 
The same concept applies to specialty care among critically ill patients.
 
Medical Emergency Team (MET) respiratory therapist Mindy Repphen-Harvey, from left, and team nurses Alisha Mangaro and Seth Long respond to a call on a simulated patient at the MUSC Health Care Simulation Center in the College of Nursing. Pulmonology fellow, Dr. David Pucci, who is part of MET, reviews training details.

For almost two years, MUSC has managed a specialty clinical team that brings critical care expertise to the bedside anywhere in the hospital. MUSC’s Medical Emergency Team (MET) program, which began in January 2007, provides a level of specialized care to patients with clinical instability or a worsening condition. The service is available to adult and pediatric patients at ART, MUSC hospital and the Children’s Hospital. The concept is to provide an immediately available, interdisciplinary, specialized team approach to patients with deteriorating health status and thus improve the quality of in-patient care.
 
MET teams consist of a critical care nurse, respiratory therapist and intensive care (ICU) physician who work with each other and the patient’s primary team in stabilizing a patient and contributing to their overall care.
 
“Nurses on the floor really need these critical care nurses and specialists to help them care for critically ill patients,” said Sheila Scarbrough, R.N., critical interventions manager, quality and outcomes in the medical director’s office and MET coordinator. Scarbrough works with Dee Ford, M.D., assistant professor of medicine, Division of Pulmonary and Critical Care Medicine who works in the Medical ICU (MICU) and Digestive Diseases ICU (DDICU).   “Floor staff are often not trained to care for critically ill patients and additionally have multiple competing demands on their time. This program activates a system to bring critical care resources immediately to a patient’s beside and activates the Admit Transfer Center to begin the process of procuring an ICU bed in case this patient requires transfer.” Scarbrough added that about 50 percent of MET’s are transferred into an ICU.
 
MET was developed from criteria documented in medical literature associated with patients who are at increased risk for a cardiopulmonary arrest. The physician-led program began as a pilot program in the main hospital’s 6E, 7E and 8E and has been offered 24/7 since October 2007.
 
MET also meets recognition and response criteria relating to a patient’s condition under the Joint Commission’s 2008 National Patient Safety Goals. In January 2007, MUHA established Policy C-149 “Medical Emergency Teams.” The concept involves a team intervention approach to providing specialized critical care to patients prior to an acute crisis such as cardiopulmonary arrest.
 
Medical staff assesses at-risk patients for changes in blood pressure, heart rate, breathing, mental status and other criteria. Medical or nursing staff can activate the MET via the paging operator
(792-3333). The MET staff member will confer with the patient’s attending physician or their designee to outline a treatment plan. The MET physician also will document findings/actions in the progress notes.
 
Cindy Hough, R.N., 6E nurse manager, is an advocate for MET among her staff and throughout the medical center. Hough and her team care for some of the hospital’s most seriously ill patients—transplant patients.
 
“MET is a positive approach to patient-centered care,” said Hough, who has more than 12 years experience as a transplant nurse. “It provides the needed resources at the right time and saves nursing time while bolstering patient safety.”
 
8E Medical Acute Care nurse manager Helena Walo, R.N., echoes that level of support for MET. Walo believes MET is not meant as a judgmental reflection on staffing care but empowers nurses to make decisions that provide the highest level of patient care.
 
“MUSC leadership has been great to support this as an important instrument to improve patient outcomes,” said Walo. “It provides a good opportunity for an ICU-level team to partner with primary care physicians and staff in following a patient’s care. Walo heads the medical center’s MET watch pilot program on 8E that provides non-ICU, inpatient nurses with specific guidelines to identify patients at high risk for needing MET team intervention.
 
An ongoing challenge according to Scarbrough is getting physicians and staff to call for MET at the first sign of a patients' decline.
 
In 2009, additional MET information will be related to patients and families via MUSC’s GetWell Network. In the meantime, Scarbrough, Ford and staff will be collecting data and evaluating numbers for trends while looking for opportunities for improvement. So far, MUSC has increased their MET call rate from less than three calls to greater than 10 calls per 1,000 discharges. Hospitals with higher MET call rates demonstrate better patient outcomes.
 
“We want families and visitors to be more aware of what MET is and that it is a level of expertise that we provide throughout the hospital system. It is a benefit for all patients of MUSC that we have this team that’s there to take care of their loved one throughout their hospital stay,” Scarbrough said.

Friday, Jan. 9, 2009