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Target exams

Red flags

• The Medical Emergency Team is one limb of the Rapid Response System, not the whole system — a strong team with a weak detection limb will still fail, because the call is never made. The afferent limb — ward staff recognising and escalating — is the weakest link in every system
• In the MERIT study, the MET was called to only about 30 per cent of patients who met calling criteria and were subsequently admitted to ICU — the system only works if the call is made, and the call is made when the ward staff are trained and empowered to make it
• The 'staff worried' criterion is the most important and the most underused element of the MET calling criteria — it is deliberately built in because experienced nurses detect deterioration before the observations cross a threshold, and the system is designed to support, not penalise, that call
• A NEWS2 of 7 or more is a clinical emergency mandating an emergency assessment by a clinician with critical care competencies within minutes — the candidate who says 'recheck in an hour' for a score of 7 has failed the question
• A single score of 3 in any one parameter (a red score) mandates urgent review regardless of the aggregate — a respiratory rate of 8 or an SpO2 of 85 per cent cannot be diluted into an apparently acceptable NEWS2 total
• The post-MET call is not the end of the episode — the registrar's responsibility is the post-MET plan: the goals of care, the ceiling of treatment, the monitoring frequency, the named responsible consultant, and the communication with the team and family
• Every deterioration is a trigger for the goals-of-care conversation, not an automatic trigger for ICU — the MET system that escalates every patient without surfacing the ceiling of care has misunderstood its purpose