The Australians were the first to formalize the concept of a
Medical Emergency Team or MET back in the 1980s. The idea
was to create a team of specific individuals that could be
called to any bedside by a page or overhead announcement.
The team would include a critical care or ICU nurse, a respi-
ratory therapist, and a charge nurse. Unlike a code team, the
MET could be summoned on the basis of a single criterion
such as increased respiration, seizure activity, or simply a gut
feeling. Instead of rushing in and taking over, the team would
work with the floor nurse to assess, identify, and intervene.
Early studies indicated significant drops in the number of
codes and the number of transfers from the floor to ICU when
MET teams were activated. The studies started to make the
rounds in medical literature and the concept made so much
sense that METs and Rapid Response Teams (RRTs) started
to pop up in isolated hospitals around the United States.
In 2000, the Institute of Medicine (IOM) issued a statement
concerning the 50,000 to 100,000 lives lost annually to
adverse events in hospitals. The IOM stated that “the decen-
tralized and fragmented nature of the HC delivery
system…contributes to unsafe conditions for patients, and
serves as an impediment to efforts to improve safety.” Dr.
Stephen Brierre, Assistant Professor of Clinical Medicine and
Critical Care Coordinator at Earl K. Long (EKL) pointed out
that, “When the IOM issues a statement like that, regulation is
quick to follow.” And he was right. In 2004 the Institute for
Healthcare Improvement (IHI) incorporated rapid response
teams as a performance indicator, first in its 100,000 Lives
Campaign, and then later in its Five Million Lives Campaign.
The trend took off, but the final impetus to put RRTs in place
came when the Joint Commission added rapid response
teams as one of its patient safety goals with an implementa-
tion target of 2009. According to the Joint Commission, “the
goal is to improve recognition and response to changes in a
patient's condition by selecting a suitable method that enables
healthcare staff members to directly request additional assis-
tance from a specially trained individual(s) when the patient's
condition appears to be worsening.” Exactly who serves on
the team and how they are summoned is left to the discretion
of the hospital, depending on levels of experience, staffing,
and patient loads. The idea is to have people on the team that
can drop what they are doing and respond immediately. For
the most part, teams are comprised of an ICU or critical care
nurse and a respiratory therapist. Others may include the
charge nurse, a house manager, or in the case of teaching
hospitals, a resident. “The old adage, 'an ounce of prevention
is worth a pound of cure' describes rapid response teams per-
fectly,” said Ochsner Critical Care Charge Nurse, Prentice
Massey, Jr.
Here in Baton Rouge we are well ahead of the curve. Our
Lady of the Lake Regional Medical Center (OLOL), Baton
Rouge General, and Ochsner, have each had rapid response
teams in place for more than three years. Cathy Guay,
Assistant Vice President of Patient Care Services at OLOL
said that when she first heard about rapid response teams, it
was through an article about the Australian study brought to
her attention by one of the hospital's intensivists. “I read the
article, but couldn't find anything else about METs in the liter-
ature. So when we created our team, we called it a MET. It
wasn't until much later that we realized the rest of the country
was calling them RRTs, but the name had already stuck,” she
laughed. The Baton Rouge General refers to its rapid
response team as a Medical Response Team or MRT. The
team was the brainchild of Julie Whitaker, Nurse Manager,
Critical Care, and Pharmacist Louis Blair, who had worked
with similar teams at hospitals in Tennessee. At Ochsner,
Prentice Massey, Jr. was delighted to find the MET in place
when he started there. “It mirrored what we were doing when
I was on active duty…I was really excited,” said Massey. At
Woman's Hospital, three distinct teams were created in 2006
to serve the hospital's unique population, according to Staci
Sullivan, Vice President of Infant and Pediatric Services.
There is a Pregnant Adult Team, a Neonatal Team, and an
Adult Post-partal or Post-surgical team. At Earl K. Long the
Medical Response Team went into action in March, 2008,
under the guidance of Dr. Stephen Brierre, who worked with
the MRT at Baton Rouge General and had witnessed positive
results firsthand. Lane Regional Medical Center got final
approval to implement its team in April, 2008 and planned to
train team members immediately.
44
Healthcare Journal of Baton Rouge
| July / August 2008 Issue | healthcarejournalbr.com
It's a win-win always. The ICU
nurses can help reduce codes
and reduce or avoid inappropri-
ate admits to ICU, the floor nurs-
es get an added level of support,
and most importantly it's a win
for the patients–we are picking up
on things a lot quicker.
-Julie Whitaker, Baton Rouge General
1905:
Publication of Alfred Binet's Intelligence Test
in Europe. Carl Jung introduces word association.
Group therapy gets its start.