Learning Objective #1: Evaluate the management of the physiologically unstable patient upon the general wards in a hospital in New Zealand

Learning Objective #2: Apply the PARIHS framework retrospectively to authenticate the recommendations of the evaluation

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Suboptimal care of patients on hospital wards that consequently develop physiological instability is a quandary of global significance. Within the last five years evidence has emerged that supports the hypothesis that general ward care can be described as deficient and, as a consequence directly contributes to adverse patient outcomes (Hillman et al. 2001; Hogetts et al. 2002; Schien et al. 1990; McQuillian et al. 1998). Suboptimal care is directly correlated with high morbidity and high mortality (Hillman et al.2001). Hillman et al. 2001 and Schien et al.1990 described and demonstrated that physiological instability may manifest for many hours prior to a cardio-pulmonary arrest. In response to the evidence the concept of a Medical Emergency Team (MET) was established and subsequently introduced in many hospitals with the primary objective being: to proactively detect and manage the physiological unstable ward patient (Schien et al. 1990). In 1996 The Medical Emergency team concept was adopted and introduced at a large tertiary hospital in New Zealand. In 2002 the efficacy of this Medical Emergency team in this hospital was evaluated, this paper details the results of the evaluation. This evaluation had two components: a) A survey of 320 ward based nursing staff to determine the extent of the knowledge that these nurses had in relation to the established Medical Emergency Team. b) A retrospective audit of ward based inpatient records to establish rates of physiological instability. The PARIHS conceptual framework has been retrospectively applied as an instrument to validate the conclusions of this evaluation and to subsequently authenticate its recommendations. The findings arising from this application shall be reported in this paper.