Outcome of Patients before and after Implementation of Medical Emergency Team Call in a Tertiary Hospital

INTRODUCTION: Poor compliance with Medical Emergency Team (MET) call processes leads to delayed interventions and preventable code blue events in hospital settings. While MET systems are designed to address patient deterioration promptly, persistent workflow inefficiencies compromise their effectiveness in achieving enhanced patient safety objectives. OBJECTIVES: PRIMARY: To reduce code blue calls by 10% through implementation of a modified early warning score card. SECONDARY: To evaluate the impact of MET call intervention on: Mortality rates. Length of stay. MET team response time. MATERIALS AND METHODS: The study employed a mixed retrospective and prospective design at a tertiary care centre. Retrospective data from February 2024 to June 2024, along with historical data from the previous two years, established baseline metrics. Prospective data collection occurred from July to September 2024. Variables included monthly MET calls, Code Blue events, ICU metrics (admission/discharge dates, length of stay, mortality, readmissions), patient diagnoses, and transfer reasons. A survey done in September assessed nurses’ understanding of the MET system and identified implementation barriers. RESULTS: Analysis of 83 MET calls revealed significant improvements after streamlining the Medical Emergency Team (MET) call process. Code Blue calls decreased dramatically from 23 (48.9%) to 1 (2.8%) (p<0.001, OR: 33.54, 95% CI: 4.27-270.56). Mortality rates showed a 20.80% reduction post-intervention, with ICU readmissions decreasing from 8 to 2. Mean ICU stay reduced from 14.77 ± 10.35 to 9.53 ± 5.58 days (p=0.007), while team response time improved from 5.87 ± 1.72 to 2.80 ± 0.70 minutes (p<0.001). The study population (mean age 58.22 years, 66.2% male) most commonly triggered MET calls due to shortness of breath (34/83) and altered sensorium (12/83). A survey of 100 ward nurses revealed 93% agreement on the MET system's effectiveness in preventing adverse events. DISCUSSIONS: Our study's findings align with several key investigations in the field. The substantial reduction in code blue rates (OR: 33.54) parallels results reported by Bristow et al.(1) and Bellomo et al.(2) The significant decrease in mortality rates and length of stay demonstrates the effectiveness of our intensivist-led MET system, contrasting with Karvellas C.J. et al.'s(3) findings where limited intensivist availability may have impacted outcomes. The improved response times mirror results reported by Soo Jin Na et al.(4) The high level of nursing satisfaction (93%) with the MET system corresponds with previous surveys by Daffurn et al.(5) and Jones D. et al.(6) indicating successful system integration. The observed improvements in interdepartmental collaboration, consistent with findings by Dimens et al. [19], suggest that our MET implementation has successfully fostered a culture of proactive emergency response and enhanced patient safety. CONCLUSION: The streamlined MET call process significantly improved patient outcomes through reduced Code Blue events, decreased mortality rates, and shortened ICU stays. Success factors included enhanced staff training, structured communication protocols, and cultivation of a rapid intervention culture. The positive nursing feedback validates the system's role in promoting teamwork and enabling timely responses to patient deterioration, enhancing patient safety and clinical effectiveness.