MET CALLS IN A METROPOLITAN PRIVATE HOSPITAL: A CROSS SECTIONAL STUDY Joyce Kant, A/Prof Peter Morley, S. Murphy, R. English, L. Umstad Melbourne Private Hospital, University of Melbourne
Background / Aims Widely implemented in hospitals throughout Australia and New Zealand since 1995 Research predominantly conducted in the public hospital sector MET calls in private hospitals may differ due to differences in: Patient demographics MET call demographics Hospital protocols and staff Other variables Aim: to examine MET call demographics and outcomes in an Australian private hospital (MPH, implemented MET in 2000)
Methods Retrospective cross-sectional data collected from: primary MET documentation patient records relevant hospital databases Inclusion criteria First MET call of an admission for: Inpatients at the Melbourne Private Hospital who received 1 MET call Admission between 1 st January and 1 st December 2016 Exclusion criteria MET call upgraded to code blue Not the first MET call of the admission
Methods Met inclusion criteria (n = 00) Included in final analysis (n = 249) Excluded because: MET call upgraded to code blue (n = 2) Patient record could not be located (n = 11) Not first MET call of this admission (n = 17)
Patient Demographics Mean (95% CI) Age (years) 67 (65, 69) Gender Male Female Admission type Medical Surgical Unspecified n = 249 % (% 95 CI) 12 117 120 119 10 55 45 48 48 4.0 (47,59) (41,5) (42, 54) (42, 54) (1.6, 6.5)
MET Call Demographics Month of MET call Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Call time In-hours (7am 10pm) Out of hours (10pm 7am) n = 249 % (% 95 CI) 18 22 2 2 2 17 20 16 27 14 27 10 17 112 7.2 8.8 1 9.2 9.2 6.8 8.0 6.4 11 5.6 11 4.0 55 45 (4.0, 10) (5., 12) (8.7,17) (5.6, 1) (5.6, 1) (.7, 10) (4.7, 11) (7.0, 15) (2.8, 8.5) (7.0, 15) (7.0, 15) (1.6, 6.5) (49,61) (9,51)
MET Call Demographics Heart rate Blood pressure Respiratory rate Desaturated/hyp oxic CNS abnormality (e.g. GCS decline) Ischemic chest pain n = 249 % (% 95 CI) 45 10 7 51 18 18 4.0 2.8 20 7.2 1.2 (1, 2) (1.6, 6.5) (0.76, 4.9) (15, 25) (4.0, 10) (0.0, 2.6) 20 8.0 (4.7, 11) 48 19 (14, 24) 1 (9.0, 17) Staff worried 97 9 (, 45) Number of patients meeting criteria 100 90 80 70 60 50 40 0 20 10 0 MET Call Triggers MET CALL TRIGGERS
24 hours prior to MET call Fulfilled MET criteria 24h prior 12h prior >12h prior n = 249 % (% 95 CI) 40 2 17 16 9.2 6.8 (12, 21) (5.6, 1) (.7, 10)
Outcomes n = 249 % (% 95 CI) Had LOMT prior to MET call 12 4.8 (2.2, 7.5) LOMT instituted/modified 24h after first MET call >24h after first MET call Admitted to intensive care unit 24h after first MET call >24h after first MET call In ICU at time of call Subsequent MET call 24h after first MET call >24h after first MET call Subsequent cardiac arrest 24h after first MET call >24h after first MET call 16 10 6 58 52 6 2 2 10 14 2 1 6.4 4.0 2.4 2 20 2.4 0.80 9.2 4.0 5.6 1.2 0.80 0.40 (.4, 9.5) (1.6, 6.5) (0.50,4.) (18, 29) (16, 26) (0.50, 4.) (0.0, 1.9) (5.6, 1) (1.6, 6.5) (2.8, 8.5) (0.0, 2.6) (0.0, 1.9) (0.0, 1.9) *LOMT = limitation of medical treatment
Outcomes Total number of MET calls before death/discharge 1 2 4 Total number of cardiac arrests before death/discharge 0 1 n = 249 % (% 95 CI) 226 18 2 246 90.8 7.2 1.2 0.80 99 1.2 (87, 94) (4.0, 10) (0.0, 2.6) (0.0, 1.91) (97, 100) (0.0, 2.6)
Outcomes Survival to discharge: Yes No Number of days between MET call and discharge/death (mean) Discharge destination Home Other acute hospital setting Aged care facility Rehabilitation Other (e.g. hospital in the home, transitional care ) Death n = 249 % (% 95 CI) 26 1 190 12 5 26 1 94.8 5.2 76 4.8 2.0 1.2 10.4 5.2 (92,98) (2.5, 8.0) (71,82) (2.2, 7.5) (0.27,.8) (0.0, 2.6) (6.6, 14) (2.5, 8.0)
Comparison Data Comparisons between MET data collected from the Melbourne Private Hospital (2015-2016) and the Royal Melbourne Hospital (2014)
Outcomes (n = 249) MPH RMH % (95% CI) (n = 4) % (95% CI) Chi 2 p-value Survival to discharge: Yes No 26 1 94.8 (92,98) 5.2 (2.5, 8.0) 291 52 85 (80, 89) 15 (11, 20) 14.6 <0.001 Number of days between MET call and discharge/death (mean) Discharge destination Home Other acute hosp. setting Aged care facility Other (e.g. rehabilitation, transitional care ) Death 190 12 5 29 1 76 (71,82) 4.8 (2.2, 7.5) 2.0 (0.27,.8) 11.6 (7.7, 16) 5.2 (2.5, 8.0) 208 28 5 50 52 61 (55, 67) 8.2 (4.8, 12) 1.5 (0.0, 2.9) 15 (10, 19) 15 (11, 20) 22.2 <0.001 MPH = Melbourne Private Hospital (private hospital) RMH = Royal Melbourne Hospital
MET call demographics Call time In-hours (7am 10pm) Out of hours (10pm 7am) Heart rate Blood pressure Respiratory rate MPH RMH (n = 249) % (95% CI) (n = 4) % (95% CI) 17 112 45 10 7 51 18 55 (49,61) 45 (9,51) 18 (1, 2) 4.0 (1.6, 6.5) 2.8 (0.76, 4.9) 20 (15, 25) 7.2 (4.0, 10) 1.2 (0.0, 2.6) 259 84 86 17 6 86 28 1 76 (70, 81) 24 (19, 0) 25 (20, 0) 5.0 (2., 7.6) 1.8 (0.2,.4) 25 (20, 0) 8.2 (4.8, 11.5) 0. (0.0, 1.0) Chi 2 p-value 27. <0.001 0.5 0.8 1.6 0.5 2.0 0.4 Desaturated/hypoxic 20 8.0 (4.7, 11) 52 15 (11, 20) 6.9 0.009 CNS abnormality (e.g. GCS decline) 48 19 (14, 24) 98 29 (2, 4) 6.7 0.01 Ischemic chest pain 1 (9.0, 17) 11.2 (1.1, 5.4) 0.01 <0.001 Staff worried 97 9 (, 45) 15 4.4 (1.9, 6.9) 4.8 0.0 MPH = Melbourne Private Hospital (private hospital) RMH = Royal Melbourne Hospital
24 hours prior to MET call Fulfilled MET criteria 24h prior 12h prior >12h prior MPH RMH (n = 249) % (95% CI) (n = 4) % (95% CI) 40 2 17 16 (12, 21) 9.2 (5.6, 1) 6.8 (.7, 10) 6 21 15 10 (6.7, 14) 6.1 (.2, 9.1) 4.4 (1.9, 6.9) Chi 2 p-value 4.0 0.046 Heart rate 6 2.4 (0.50, 4.) 1.2 (0.0, 2.6) 6 1.8 (0.15,.4) 0.87 (0.0, 2.0) 0.5 0.8 Blood pressure 4 12 1.6 (0.045,.2) 4.8 (2.2, 7.5) 2 15 0.58 (0.0, 1.5) 4.4 (1.9, 6.9) 1.6 0.5 Respiratory rate 1 2.1 (0.0, 2.6) 0.40 (0.0, 1.19) Desaturated/hypoxic 10 4.0 (1.6, 6.5) 7 CNS abnormality (e.g. decreased GCS, seizure ) MPH = Melbourne Private Hospital (private hospital) 7 0 2.0 (0.1,.8) 0 2.0 (0.1,.8) 2.0 0.4 2.0 0.2 0 0 4 1.2 (0.0, 2.5) 2.9 0.09 RMH = Royal Melbourne Hospital
Conclusions Outcomes of MET calls differ between the Melbourne Private Hospital (private) and Melbourne Public Hospital (public) More survive to discharge and are discharged home from the Melbourne Private Hospital (95%, 76% vs 85%, 61% Fewer patients have subsequent MET calls at the Melbourne Private Hospital More have a LOMT prior to/after MET call at the Royal Melbourne Hospital No difference in ICU admissions following MET call Some MET call demographic differences More MET calls out of hours at the Melbourne Private Hospital Some differences in MET call triggers (Worried: 9% vs 4.4%) Need to understand the local issues
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Outcomes Had LOMT prior to MET call 12 LOMT instituted/modified 24h after first MET call >24h after first MET call Admitted to intensive care unit 24h after first MET call >24h after first MET call In ICU at time of call MPH RMH (n = 249) % (95% CI) (n = 4) % (95% CI) 16 10 6 58 50 6 2 4.8 (2.2, 7.5) 6.4 (.4, 9.5) 4.0 (1.6, 6.5) 2.4 (0.50,4.) 2 (18, 29) 20 (16, 26) 2.4 (0.50, 4.) 0.80 (0.0, 1.9) 9.2 (5.6, Subsequent MET call 1) 24h after first MET 2 4.0 (1.6, MPH call = Melbourne Private Hospital 10 (private hospital) 6.5) Chi 2 p-value 50 15 (10, 19) 14.7 <0.001 57 2 4 7 6 10 0 64 0 17 (12, 21) 7 (4, 10) 10 (6, 14) 21 18 (14, 2) (0.67, 4.8) 0 5. 0.02.4 0. 19 (14, 2) 8.8 (5., RMH = Royal Melbourne 8.8 Hospital 0.00 12)
Patient demographics MPH (mean) RMH (mean) t-value p-value Age (years) 67 66 0.25 0.6 (n = 249) MPH % (95% CI) (n = 4) RMH % (95% CI) Chi 2 p-value Gender Male Female 12 117 55 (47,59) 45 (41,5) Admission type Medical Surgical Unspecified 120 119 10 48 (42, 54) 48 (42, 54) 4.0 (1.6, 6.5) 199 144 58 (52, 64) 42 (6, 48) 1.2 0. MPH = Melbourne Private Hospital (private hospital) RMH = Royal Melbourne Hospital
24 hours prior to MET call Heart rate Blood pressure Respiratory rate n = 249 % (% 95 CI) 6 4 12 1 2.4 1.2 1.6 4.8 2.1 0.40 (0.50, 4.) (0.0, 2.6) (0.045,.2) (2.2, 7.5) (0.0, 2.6) (0.0, 1.19) Desaturated/hypoxic 10 4.0 (1.6, 6.5) CNS abnormality (e.g. decreased GCS, seizure ) 0 0