Dedicated Medical Emergency Teams Respond to Inpatient Emergencies

While hospitals are designed to treat the sick and injured, sometimes situations occur within the walls of a healthcare facility that require rapid clinical intervention: an unresponsive patient in a post-anesthesia care unit, a fall by a family member in a waiting room, or an employee experiencing new-onset chest pain (due to myocardial infarction). In these cases, rapid response teams are often utilized.

Cleveland Clinic Main Campus has two dedicated adult rapid response teams – the Adult Medical Emergency Team (AMET) and the Cardiac Medical Emergency Team (CMET). Other rapid response teams that also support the main campus are the Pediatric Medical Emergency Team (PMET) and Don Marten’s Mobile Emergency Response Team (MERT). They can be activated by any employee, patient or family member when an individual is decompensating from their previous health status or becomes ill or injured while on main campus.

“Many hospitals do not have dedicated nurses and respiratory therapists on their rapid response teams; instead, nurses typically have other primary work responsibilities with emergency response added as secondary/dual responsibility,” says Rosslyn VanDenBossche, MBA, BSN, NE-BC, Assistant Director of Nursing for the Heart and Vascular Institute & Critical Care at Cleveland Clinic. “We are fortunate to have multiple emergency teams committed to providing world-class, immediate emergency care.”

RNs are a critical part of METs

METs working at Cleveland Clinic Main Campus typically include a dedicated registered nurse, a dedicated respiratory therapist, and an attending physician or advanced practice nurse. There are 20 dedicated RNs on the AMET and CMET teams, with more than half working on both teams.

“In MET activations, the team provides rapid clinical assessment and interventions to individuals who are decompensating quickly, partner with the primary team, assist with immediate tests or procedures, and expedite patient transfers to a higher level of care,” says VanDenBossche.

The ultimate goal of METs is to intervene with urgent care before a patient experiences a Cardiopulmonary Arrest (CPA) by recognizing warning signs and taking swift activation when criteria is met. Ideally, we want the CPAs to occur in the ICU where resources and equipment are more readily available.

The strategy works and the educational efforts paid off: In 2017 there were 86 non-ICU codes at Cleveland Clinic’s Main Campus, compared to 171 in 2010. “Every year, our goal is to decrease our Cardiopulmonary Arrests outside of the ICU and increase out MET activations,” says VanDenBossche. In 2010, AMET was activated 2,348 times. Last year, AMET was activated 5,985 times.

AMET and CMET (established in 2007 and 2008, respectively) respond to the same types of emergencies, but differ only by responding locations; CMET’s primary response location is the Sydell & Arnold Miller Family Pavilion, home to Cleveland Clinic’s Heart & Vascular Institute, and AMET responds to all other remaining locations on main campus.

A second AMET RN and AMET response team is stationed in Cleveland Clinic’s Crile Building weekdays 7 a.m. to 7:30 p.m. to assist MERT with servicing the ambulatory population in that area.

“This second team was implemented as a response to the anticipated increase in activations due to the addition of the new Taussig Cancer Center, increased concurrent activations, and more in-patients traveling to these ambulatory locations for care, says VanDenBossche. “AMET in Crile helps bridge the gap between time of activation to MERT arrival, which could range from two to 10 minutes or more, and bridges the gap of distance for providers when an activation involves an inpatient.”

RNs provide education, conduct research

“MET nurses are an incredible group who are highly engaged and committed to patient safety and to the development of our caregivers,” says VanDenBossche. “They are informal leaders.” As such, their role extends beyond helping out in rapid response situations.

Education is also a primary responsibility for the MET RNs. Nurses and nursing students shadow the MET nurses and receive hands-on experience with defibrillators and crash carts. MET RNs also educate caregivers on American Heart Association’s Get with the Guidelines®.

Because of their vast experience and skill set, Cleveland Clinic’s MET nurses are recognized as leaders in the field of rapid response care. They present at conferences, both locally and nationally, including the Ohio Association for Healthcare Quality conference and the Rochester Cardiac Nursing Conference. With recent IRB approval, AMET launched their inaugural nursing research study on the relationship between cardiopulmonary arrest rates and the use of a dedicated rapid response team. This is their first nursing study which will serve as the foundation for additional phases of research in rapid response care.

Learning from code events

Code events that occur outside of the ICU at Cleveland Clinic’s Main Campus are carefully reviewed, twice monthly by the Critical Response and Resuscitation Committee, which oversees all METs. In addition, nursing holds a monthly Nursing Event Review and Educational Planning Sessions (NEREPS) attended by clinical nurse specialists, nurse managers, assistant nurse managers, an RN from the American Heart Association training center and MET RNs.

“We review all code events from the previous month, focusing on the 24 hours leading up to the code,” says Kelly Lichman, BSN, RN, PCCN, Nurse Manager of the Heart & Lung Transplant Unit and co-chair of the NEREPS Committee. The committee reviews patient vital signs, lab work, medications, telemetry, physician notes and nursing notes. It examines how well caregivers followed procedures and escalation protocols.

Information gathered during NEREPS is relayed back to nursing units to educate caregivers. “We discuss areas that were missed, good catches or if this was an unforeseen situation that, despite our best efforts, could not have been prevented,” says Lichman. The data also guides continuous improvement initiatives.