Trial registered on ANZCTR


Trial ID
ACTRN12614000951651
Ethics application status
Approved
Date submitted
28/08/2014
Date registered
4/09/2014
Date last updated
13/11/2015
Type of registration
Prospectively registered

Titles & IDs
Public title
Characteristics and Outcomes of Medical Emergency Team (MET) Calls in New Zealand - a Prospective Observational Study
Scientific title
A multicentre prospective observational study of all patients who require a Medical Emergency Team review (or local equivalent) in New Zealand hospitals over a 2 week period to identify the characteristics & outcome of this population.
Secondary ID [1] 285248 0
Nil
Universal Trial Number (UTN)
U1111-1160-9956
Trial acronym
NZMET
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Medical Emergency Teams 292888 0
Deteriorating hospitalised patients 292889 0
Condition category
Condition code
Respiratory 293179 293179 0 0
Other respiratory disorders / diseases
Surgery 293180 293180 0 0
Other surgery
Public Health 293181 293181 0 0
Health service research

Intervention/exposure
Study type
Observational
Patient registry
False
Target follow-up duration
Target follow-up type
Description of intervention(s) / exposure
Observational study of patients who require Medical Emergency Team (MET) review in 11 New Zealand hospitals over a 2 week period.

Data collected will include demographics of these patients, their physiological data (vital signs) that necessitated the MET review, who called for & who attended the MET, interventions performed by the MET, any decisions regarding further care (including end-of-life care) made by the MET as a result of their attendance and a review of the patient's status at 30 days post-MET.
Intervention code [1] 290128 0
Not applicable
Comparator / control treatment
N/A
Control group
Uncontrolled

Outcomes
Primary outcome [1] 293045 0
Variation in MET calling patterns between NZ hospitals by comparing data from each
Timepoint [1] 293045 0
2 week period of all MET calls
Primary outcome [2] 293090 0
Trigger(s) leading to activation of the MET within each NZ hospital by comparing data from each
Timepoint [2] 293090 0
2 week period of all MET calls
Secondary outcome [1] 310315 0
End-of-life care or limitation of medical treatment decisions that may occur after review by a MET
Timepoint [1] 310315 0
2 week period of all MET calls
Secondary outcome [2] 310316 0
30 day mortality of all patients who receive a MET call
Timepoint [2] 310316 0
30 days post MET call

Eligibility
Key inclusion criteria
All patients who receive a MET call at one of the study centres during the 2 week observational period
Minimum age
No limit
Maximum age
No limit
Gender
Both males and females
Can healthy volunteers participate?
No
Key exclusion criteria
None

Study design
Purpose
Natural history
Duration
Cross-sectional
Selection
Defined population
Timing
Prospective
Statistical methods / analysis

Recruitment
Recruitment status
Completed
Date of first participant enrolment
Anticipated
Actual
Date of last participant enrolment
Anticipated
Actual
Date of last data collection
Anticipated
Actual
Sample size
Anticipated
Actual
Recruitment outside Australia
Country [1] 6321 0
New Zealand
State/province [1] 6321 0

Funding & Sponsors
Funding source category [1] 289869 0
Self funded/Unfunded
Name [1] 289869 0
Address [1] 289869 0
Country [1] 289869 0
Primary sponsor type
Individual
Name
Alex Psirides
Address
Intensive Care Unit
Wellington Regional Hospital
Riddiford Street
Newtown
Wellington
6021
Country
New Zealand
Secondary sponsor category [1] 288550 0
Individual
Name [1] 288550 0
Anne Pedersen
Address [1] 288550 0
Intensive Care Unit
Wellington Regional Hospital
Riddiford Street
Newtown
Wellington
6021
Country [1] 288550 0
New Zealand

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 291592 0
HDEC New Zealand
Ethics committee address [1] 291592 0
Ministry of Health
No 1 The Terrace
PO Box 5013
Wellington
6145
Ethics committee country [1] 291592 0
New Zealand
Date submitted for ethics approval [1] 291592 0
29/08/2014
Approval date [1] 291592 0
16/09/2014
Ethics approval number [1] 291592 0
14/CEN/143

Summary
Brief summary
Patients admitted to hospital wards have increasingly complex conditions and a growing number of co-morbidities. Medical emergency teams (METs) have been introduced into hospitals to identify, review and treat acutely deteriorating ward patients in an attempt to reduce cardiac arrests, serious adverse events and unplanned admissions to the intensive care unit.

To date there have been limited studies examining the use of the MET model of care in New Zealand. Knott and others conducted a retrospective cohort study in Wellington, New Zealand. Review by the hospital’s MET was associated with a doubling of documentation of advanced care directives (from 32 before to 64% after MET review).

Psirides and others conducted a cross-sectional study of recognition and response systems in NZ public hospitals during October 2011. They found considerable variation in the thresholds for activation of RRTs between hospitals.

Pedersen and others have described the models and activities of critical care outreach teams in New Zealand hospitals & have shown considerable variance in the type of work conducted by such teams with variable involvement in responding to deteriorating ward patients.

Finally, Drower and co-workers conducted a before and after study to examine the effect of introducing a new vital sign chart, an escalation policy and an expanded response by the cardiac arrest team on the incidence of cardiac arrests in Waikato hospital. They found that this combined approach was associated with a reduction in the incidence of cardiac arrests from 4.67 during 2009– 2010 and 2.91 during 2010–2011 (mean difference of 1.77, 95%CI 0.59–2.94). This study was limited by the presence of a large amount of missing information about emergency calls.

To date no study has assessed the characteristics and outcomes of patients subject to MET review in New Zealand.

We plan to conduct a multi-centre prospective observational study in New Zealand to assess the characteristics and outcomes of Medical Emergency Team (MET) (or equivalent) calls occurring over a two week period. The term ‘MET’ is used to refer to any hospital system that can be activated to review deteriorating hospital inpatients based on either pre-determined physiological criteria or staff concern.

Specifically, we will assess:
1. The variation in the number of MET calls per week between hospitals

2. The timing of these calls – both in relation to time of day, day of week, and in relation to hospital admission.

3. The trigger(s) leading to activation of the MET activation

4. The immediate outcome of the patient at the conclusion of the MET call (cardiac arrest, other death during call, remained on ward, transferred to another ward, admitted to HDU / ICU, other)

5. Details of limitations of medical therapy immediately before and after the call (NFR, for full care, for limited care).

6. Disposition at hospital discharge (home, rehab, other hospital, place other than home, deceased) or whether remained in hospital 30 days after termination of study.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 51054 0
Dr Alex Psirides
Address 51054 0
Intensive Care Unit
Wellington Regional Hospital
Riddiford Street
Newtown
Wellington
6021
Country 51054 0
New Zealand
Phone 51054 0
+6443855999
Fax 51054 0
Email 51054 0
alex.psirides@ccdhb.org.nz
Contact person for public queries
Name 51055 0
Dr Alex Psirides
Address 51055 0
Intensive Care Unit
Wellington Regional Hospital
Riddiford Street
Newtown
Wellington
6021
Country 51055 0
New Zealand
Phone 51055 0
+6443855999
Fax 51055 0
Email 51055 0
alex.psirides@ccdhb.org.nz
Contact person for scientific queries
Name 51056 0
Dr Alex Psirides
Address 51056 0
Intensive Care Unit
Wellington Regional Hospital
Riddiford Street
Newtown
Wellington
6021
Country 51056 0
New Zealand
Phone 51056 0
+6443855999
Fax 51056 0
Email 51056 0
alex.psirides@ccdhb.org.nz