This study aims to analyse trends and characteristics of medical emergency team (MET) calls in a tertiary urology unit in Melbourne, Australia. MET calls are a form of critical care rapid response system to derangement in vital signs. Acute urological conditions (e.g. urosepsis or obstructive uropathy) commonly result in critical illness, hence assessing patterns in critical care responses is of note to urological practice.

Retrospective review was performed of all MET calls/code blues occurring in a tertiary urology unit in Melbourne, Australia over a 12-month period (Mar 2024-2025). Data-points analysed included triggers of MET calls, patient comorbidities and admission diagnoses, management implemented and mortality outcomes.

Over a 12-month period, 125 MET calls/code blues occurred in this urology unit. 66 MET calls occurred during 6,272 elective admissions (1.05%), and 59 MET calls occurred during 953 emergency admissions (6.2%). Common triggers for MET call included hypotension (28%), tachycardia (21.6%), tachypnoea (16%), syncope/presyncope (7.2%), reduced GCS (6.4%), hypoxia (5.6%), pain crisis (4.8%) and chest pain (4%). Sepsis was the underlying cause in 27.2% of cases. A significant proportion of MET calls were due to non-urological causes (65.6%). 69.6% of MET calls that occurred were post-operative, and of post-operative MET calls, 29.1% occurred post endourological stone surgery (URS, PCNL), 25.3% after cystoscopic procedures (cystoscopy, clot evacuation, SPC), 17.7% after transurethral resection (TURP, TURBT or HOLEP), 13.9% after cystoscopic stent insertion, 8.9% after laparoscopic renal surgery, and 5.1 after major open surgery (open nephrectomy or cystectomy). The patient cohort was significantly comorbid with median Charlson comorbidity index of 5, and rates of IHD, CCF, COPD, CVA, dementia, diabetes and CKD of 31.6%, 15.8%, 15.8%, 16.8%, 9.5%, 32.6% and 26.32% respectively. Management included IV fluid resuscitation in 52% of cases, commencement/broadening of antibiotic cover in 24.8%, oxygen supplementation in 16%, electrolyte supplementation in 15.2%, diuresis and antiarrhythmic medication in 8% each, bronchodilatory and inotropic medications in 5.6% each, and blood transfusion in 2.4% of cases. Regarding outcomes, 78.4% of patients were stabilised on the ward, 12% transferred to ICU, 6.4% transferred to another facility, 1.6% palliated and 1.6% passed away during the MET call. Long terms morbidity was significant, with 30-day mortality rate of 10.4%.

The rate of non-urological issues requiring critical care response is high – warranting co-management with general/internal medicine teams. Sepsis is a common underlying trigger for critical care response in urology inpatients. The most common management implemented in critical care responses was IV fluid resuscitation and commencement/broadening of antibiotic cover – consideration must be given to early implementation of these measures to avoid need for critical care response.