Introduction

Medical emergency teams (MET) were introduced to respond to clinical deterioration usually in the form of vital sign abnormalities¹. These abnormalities are also present in the dying patient where aggressive intervention may not be in the patient’s best interest².

Methods

Patterns of care received by two cohorts of cancer patients, those who experienced at least one MET call within their final week of life (n=50) and those who did not (n=50) were compared in a cross sectional study.  Medical charts were reviewed for the occurrence of identified positive and negative quality of death indicators. Quality of death scores were derived by attributing one point for each positive indicator received and each negative indicator not received, a higher score corresponded with a greater quality of death.

Results

Patients who did not receive a MET call had a significantly higher median quality of death score when compared with the patients who did receive a MET call (10.0 versus 9.0, p=0.01). For patients who had a MET call, the MET directly influenced end-of-life care for 38% (n=19).  This subgroup had a higher quality of death score (9.6 versus 8.2, p=0.02) than patients where the MET did not influence their end-of-life care (n=31). Amongst patients who received a MET call, initial outcome was significantly different (p=0.01) with 5% of patients where the MET team directly influenced end-of-life admitted to the intensive care unit (ICU) compared to 39% of patients whose end-of-life care was not directly influenced by the MET.

Conclusion

These results support existing evidence that ICU is not an appropriate environment for optimal care of a dying cancer patient.  End-of-life care made up a substantial part of the role of the MET within this study setting and as such, comprehensive training in aspects of palliative care may be of benefit to members of the MET.