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).