Association of medical emergency team activation in the 24-hour postoperative period with length of stay and in-hospital mortality

Medical emergency team (MET) activations were designed to improve patient safety and outcomes by providing timely and specialised care to patients experiencing clinical deterioration. The primary objective of this study was to describe the association between MET events in the early (24-h) postoperative period and in-hospital mortality as well as length of stay. A retrospective data linkage study was performed of prospectively collected data from patient administrative data and the MET database at Launceston General Hospital located in Tasmania, Australia. Over five years, 109,116 operating room cases fulfilled the inclusion criteria, of which 85,235 were the first operating room case in a unique admission episode after exclusions. A MET event within the first 24 h after surgery was associated with an increased median length of stay from 0.16 to 4.00 days with a median difference of 2.96 days (95% confidence interval (CI) 2.86 to 3.08) and more than doubled the hazard of mortality for each day a patient remained in hospital after completion of surgery (hazard ratio 2.3, 95% CI 1.9 to 2.8). Emergency surgical patients were at higher risk. Of recorded MET triggers, cardiac arrest was the most strongly associated event with in-hospital mortality. Notably, staff concern as a trigger for MET activation was associated with a hazard nearly as great as chest pain. Other MET triggers that reached statistical significance were bleeding, respiratory rate more than 36/min, peripheral oxygen saturations less than 84% and systolic blood pressure less than 80 mmHg. Despite being frequent, MET events should be regarded as a serious marker of an adverse patient journey that may warrant higher resource allocation.