The medical emergency team and end-of-life care: a pilot study

OBJECTIVES: To assess the characteristics of patients who died in a teaching hospital and the role of the medical emergency team (MET) in their end-of-life care. METHODS: This was a retrospective analysis of 105 deaths over the month of May 2005 by a blinded investigator, who documented patient age, parent hospital unit, comorbidities, presence and timing of not-for-resuscitation (NFR) designation, and presence and timing of first MET review. We analysed differences between medical versus surgical patients, NFR versus non-NFR patients, and MET-reviewed versus non-MET-reviewed patients. RESULTS: Of the 105 patients who died, 80 were medical patients and 25 were surgical patients. Five patients were not designated NFR at the time of death, and three of these had antecedent MET criteria in the 24 hours before death. Of the 100 patients who were designated NFR at the time of death, 35 received a MET call during their admission. Of the 35 MET calls, 10 occurred on the same day as the patient's death, and 12 on the same day as the NFR designation. Documentation of NFR status occurred later in the admission for patients who received a MET call than for those who did not receive a MET call (mean +/-SD, 13.3 +/-16.1 versus 5.3 +/-10.8 days after admission; P = 0.003). Hypotension, hypoxia and tachypnoea were the most common MET triggers, and pulmonary oedema, pneumonia and acute coronary syndromes were the most common reasons for the deterioration in the patient's condition. Following the MET review, patients were admitted to the ICU and newly classified as NFR in 15 and nine of the 35 MET calls, respectively. CONCLUSIONS: Most patients who died in our hospital were designated NFR at the time of death. A third of these patients were seen by the MET before death. In about 10% of cases, the MET participated in the decision to designate the patient NFR.