Bendigo Health ICU Manual
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      • FAST HUGS IN BED PLEASE
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      • Assessing for extubation
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        • Beta-blockers
        • Neuromuscular Blocking Agents
        • Aperients / Laxatives
        • Prokinetics
    • Care bundle >
      • Post-cardiac arrest care (TTM) (PROMPT)
      • Care of the Post-Operative Patient
      • Spinal Trauma- CPG's (includes cervical spine clearance) (PROMPT)
      • Management Of Uncontrolled, Life Threatening Bleeding (Massive Exsanguination) (PROMPT)
    • Clinical Protocols + Guidelines >
      • Approach to patient with suspected influenza
      • RAPID INFLUENZA AND RSV TESTING
      • Stroke Protocol (SCV Oct 2018)
    • NIV >
      • Domiciliary (Home) non-invasive ventilation (NIV)/CPAP patients
      • NIV (PROMPT)
    • Tracheostomy Management
    • PICCO decision making tree
    • CRRT
    • Procedures
    • The Dying Person in ICU >
      • The Dying Patient
      • Care of the Dying Patient
      • Organ & Tissue Donation
    • Patient transfers >
      • Emergency calls to the helicopter pad
      • Transferring ICU patients >
        • Intra & Interhospital transfers
        • MRI transfers - special considerations
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            • Radiology Conference
            • ‘Labs/lytes’ session or equipment or Journal club
            • Tracheostomy day for doctors
            • Deteriorating patient workshop
            • Ambu Bronchoscope and Cook Surgical Airway CPD workshop
            • Crucial Conversation workshop
            • Team Skills simulation day
            • ALS Simulation
            • Level 1 ECHO training
            • External Speakers
            • VICEN
            • Bendigo ICU Journal club
          • Expectations for Consultants
          • Expectations for all ICU Registrars
          • Expectations for HMOs
          • Medical Student program
          • North West Training Hub
          • ICU Simulation
        • CICM Primary Exam education
        • Curated educational videos & websites >
          • Virtual bronchoscopy
        • Mandatory training for medical staff
      • Term Assessments >
        • Registrar Assessments and In-Training Evaluation Reports (ITERs)
        • Registrar term assessments (consultant access only) >
          • Term Assessment form (consultant access only)
      • Procedures and Skills Competency Assessments >
        • Bendigo Health ICU DOPS
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        • CICM Tracheostromy WCA
        • CICM Pleural Drain WCA
        • CICM Ventilation WCA
        • CICM ALS & BLS WCA
        • CICM Communication WCA
        • CICM Brain Death WCA
        • CICM OCA
        • ANZCA DOPS
        • ACEM DOPS
      • Echocardiography in ICU
      • BASIC Provider & Instructor Courses
      • Paediatric BASIC Provider & Instructor Courses
      • Other education opportunities
      • Paediatric crit care education
      • Useful learning links
    • Research & Quality >
      • Research >
        • STARRT AKI
        • SuDDICU
        • PLUS study
        • Recent Publications
    • Well-being >
      • Mentorship
      • Looking after yourself and colleagues
    • Medical Students in ICU
  • Paediatric ICU
    • Introduction
    • GO NOW Criteria
    • Admission criteria for paediatric HDU/ICU
    • Commonly used SCV Paediatric Guidelines >
      • Asthma
      • Bronchiolitis >
        • Bronchiolitis
        • Respiratory Distress Score for monitoring patients with bronchiolitis on HFNC and CPAP
      • Croup
      • Diabetic ketoacidosis >
        • Algorithm for the management of DKA (to be read in conjunction with SCV guideline)
        • SCV - Diabetic ketoacidosis
      • Seizures >
        • Febrile seizures
        • Non-febrile seizures
      • The Septic Child >
        • Assessment & Management (SCV)
        • Criteria for rapid ICU admission of children with sepsis
      • Dehydration >
        • Dehydration
        • IV fluid management
    • Paediatric Crit Care Education >
      • ED/Paeds education sessions
      • Paediatric equipment 'treasure hunt'
      • Curated paediatric educational videos
      • Other paediatric crit care education opportunities
    • Paediatric Resus Card
  • Emergency!
    • Code Blue: ALS algorithms >
      • Adult ALS algorithm
      • Paediatric ALS algorithm
      • Obstetric cardiac arrest flowchart
    • Emergency algorithms/mnemonics >
      • Airway
      • Breathing
      • Circulation
      • Disability
    • MET calls: common scenarios >
      • Staff concern
      • Hypoxic Type 1 Respiratory Failure
      • Hypercapnoeic Type 2 Respiratory Failure
      • Atrial Fibrillation
      • Hypotension and CV Shock
      • Altered consciousness
      • The Agitated Patient
      • Interface with other disciplines
      • Oliguria/Anuria
    • MET calls: resources
    • Paediatric Resus Card
E Broadfield 2019

Your role as the ICU registrar (or resident) at a MET call

MET calls can prove to be one of the most challenging aspects of your job, often not because of the clinical scenario, but because of inter-departmental relationships and politics. Responsibilities at MET calls also vary across institutions, so just as a reminder (in Bendigo):
  • The clinical lead is the Medical Registrar, not the ICU registrar. This is because only a small percentage of MET call patients actually require HDU/ICU and ongoing medical management is often by the medical team
  • Your responsibility is to assess:
    • Does the patient require resuscitation (ABCD)?
    • Does the patient require HDU/ICU and is patient an appropriate candidate for admission?
  • If the answer to the above questions is 'no', extricate yourself from the situation. The ongoing management should be provided by the parent team +/- medical registrar as appropriate.
  • You should not complete MR85s on other team’s patients. This is solely the responsibility of the parent team. If their registrar does not feel comfortable doing this, it should be escalated to the consultant (their responsibility). You can provide your opinion (supported by the ICU consultant) on whether they are a candidate for ICU and if you think MET calls/resuscitation are in the patient’s best interests, but the final decision and therefore documentation lies with the parent team (or delegate on-call team).
  • At all times, your first priority is to our ICU patients and therefore if you are busy performing time critical assessments/procedures on an ICU patient when a MET call is called, please let the Access Nurse know that you are currently unable to attend the MET and ask them to let you know if there are any ongoing concerns. This is particularly pertinent when there is a solo doctor on the unit.
  • If for any reason you need additional help or support, please call the Intensivist on duty (or Outreach consultant during the day).
  • Overview
  • ​MET call team behaviour
  • MET call team set-up
  • Your role in a MET call team
  • Team communication 
  • Types of problems seen on MET calls
  • ​A framework for approaching a MET call as an ICU registrar
  • Home
  • Administration
    • Team members
    • Useful contacts
    • Orientation & Guides
    • Roster rules for ICU junior doctors (Appendix A)
    • App user tips >
      • FindMyShift
      • Kronos
      • Synapse
      • Offsite access to additional email addresses
    • VHIMS >
      • VHIMS Resources (intranet only)
      • How to enter a VHIMS (intranet only)
    • Social Media Etiquette
    • BASIC equipment loan
    • Medical Students in ICU
    • ICU Consultants Only >
      • Echuca Telehealth Consults
      • Shift swap form for consultants
      • Electronic TiL request form
      • CME Claim Process
    • ERH VITCCU
  • Clinical
    • Interface with ED & home teams >
      • ED
      • Surgical teams
      • Cardiology
      • Paediatrics
    • Admissions & Discharges >
      • Admissions & Discharges
      • Admission guidelines for surgical elective and emergency operations
    • Admission guidelines for surgical elective and emergency operations
    • Daily ICU review & care >
      • FAST HUGS IN BED PLEASE
      • Oxygen prescribing
      • Oxygen - Paediatric considerations
      • Care of the Invasively Ventilated Patient – Adult Patient (PROMPT)
      • Assessing for extubation
      • Nutrition in ICU
      • Thiamine prescribing
      • Patient Diaries
    • Drugs & Infusions >
      • Inpatient prescribing practices
      • Common ICU Drugs
      • Drug Infusions A-Z
      • Drugs by system/action >
        • Antibiotics
        • Diuretics
        • Antithrombotic therapy
        • Analgesics in ICU
        • Antipyretic
        • Anticonvulsants
        • Antiplatelets
        • Antihypertensives
        • Beta-blockers
        • Neuromuscular Blocking Agents
        • Aperients / Laxatives
        • Prokinetics
    • Care bundle >
      • Post-cardiac arrest care (TTM) (PROMPT)
      • Care of the Post-Operative Patient
      • Spinal Trauma- CPG's (includes cervical spine clearance) (PROMPT)
      • Management Of Uncontrolled, Life Threatening Bleeding (Massive Exsanguination) (PROMPT)
    • Clinical Protocols + Guidelines >
      • Approach to patient with suspected influenza
      • RAPID INFLUENZA AND RSV TESTING
      • Stroke Protocol (SCV Oct 2018)
    • NIV >
      • Domiciliary (Home) non-invasive ventilation (NIV)/CPAP patients
      • NIV (PROMPT)
    • Tracheostomy Management
    • PICCO decision making tree
    • CRRT
    • Procedures
    • The Dying Person in ICU >
      • The Dying Patient
      • Care of the Dying Patient
      • Organ & Tissue Donation
    • Patient transfers >
      • Emergency calls to the helicopter pad
      • Transferring ICU patients >
        • Intra & Interhospital transfers
        • MRI transfers - special considerations
    • Welfare & other supports for patients and family >
      • Visiting times
      • Social work, pastoral care & aboriginal hospital liaison officer support
      • Interpreter services
      • Patient relations office
  • Beyond Clinical
    • Education & Training >
      • Education & Training >
        • Learning and Training in ICU
        • Bendigo Health ICU Medical Education Principles >
          • Departmental overview
          • Medical Stream
          • Medical Weekly Schedule >
            • Wednesdays
            • Airway training (hands-on-real time) in Operating theatre
            • Radiology Conference
            • ‘Labs/lytes’ session or equipment or Journal club
            • Tracheostomy day for doctors
            • Deteriorating patient workshop
            • Ambu Bronchoscope and Cook Surgical Airway CPD workshop
            • Crucial Conversation workshop
            • Team Skills simulation day
            • ALS Simulation
            • Level 1 ECHO training
            • External Speakers
            • VICEN
            • Bendigo ICU Journal club
          • Expectations for Consultants
          • Expectations for all ICU Registrars
          • Expectations for HMOs
          • Medical Student program
          • North West Training Hub
          • ICU Simulation
        • CICM Primary Exam education
        • Curated educational videos & websites >
          • Virtual bronchoscopy
        • Mandatory training for medical staff
      • Term Assessments >
        • Registrar Assessments and In-Training Evaluation Reports (ITERs)
        • Registrar term assessments (consultant access only) >
          • Term Assessment form (consultant access only)
      • Procedures and Skills Competency Assessments >
        • Bendigo Health ICU DOPS
        • CICM CVC WCA
        • CICM Tracheostromy WCA
        • CICM Pleural Drain WCA
        • CICM Ventilation WCA
        • CICM ALS & BLS WCA
        • CICM Communication WCA
        • CICM Brain Death WCA
        • CICM OCA
        • ANZCA DOPS
        • ACEM DOPS
      • Echocardiography in ICU
      • BASIC Provider & Instructor Courses
      • Paediatric BASIC Provider & Instructor Courses
      • Other education opportunities
      • Paediatric crit care education
      • Useful learning links
    • Research & Quality >
      • Research >
        • STARRT AKI
        • SuDDICU
        • PLUS study
        • Recent Publications
    • Well-being >
      • Mentorship
      • Looking after yourself and colleagues
    • Medical Students in ICU
  • Paediatric ICU
    • Introduction
    • GO NOW Criteria
    • Admission criteria for paediatric HDU/ICU
    • Commonly used SCV Paediatric Guidelines >
      • Asthma
      • Bronchiolitis >
        • Bronchiolitis
        • Respiratory Distress Score for monitoring patients with bronchiolitis on HFNC and CPAP
      • Croup
      • Diabetic ketoacidosis >
        • Algorithm for the management of DKA (to be read in conjunction with SCV guideline)
        • SCV - Diabetic ketoacidosis
      • Seizures >
        • Febrile seizures
        • Non-febrile seizures
      • The Septic Child >
        • Assessment & Management (SCV)
        • Criteria for rapid ICU admission of children with sepsis
      • Dehydration >
        • Dehydration
        • IV fluid management
    • Paediatric Crit Care Education >
      • ED/Paeds education sessions
      • Paediatric equipment 'treasure hunt'
      • Curated paediatric educational videos
      • Other paediatric crit care education opportunities
    • Paediatric Resus Card
  • Emergency!
    • Code Blue: ALS algorithms >
      • Adult ALS algorithm
      • Paediatric ALS algorithm
      • Obstetric cardiac arrest flowchart
    • Emergency algorithms/mnemonics >
      • Airway
      • Breathing
      • Circulation
      • Disability
    • MET calls: common scenarios >
      • Staff concern
      • Hypoxic Type 1 Respiratory Failure
      • Hypercapnoeic Type 2 Respiratory Failure
      • Atrial Fibrillation
      • Hypotension and CV Shock
      • Altered consciousness
      • The Agitated Patient
      • Interface with other disciplines
      • Oliguria/Anuria
    • MET calls: resources
    • Paediatric Resus Card