MERIT (Medical Early Response Intervention and Therapy)

The MERIT Study is a cluster randomised control trial, which incorporated 23 hospitals across Australia.
It is one of the largest studies of its kind undertaken anywhere in the world. The purposes of the study were to test the hypotheses that the implementation of a hospital-wide Medical Emergency Team (MET) System can reduce the aggregate and individual incidence rate of:

Unplanned admission to the Intensive Care Units (ICU's);
Cardiopulmonary arrests;
In-hospital deaths.

This study is financed through the NHMRC http://www7.health.gov.au/nhmrc, the Australia Council for Safety and Quality in Healthcare and ANZICS http://www.anzics.com.au (Australia and New Zealand Intensive Care Society) Foundation. It has received extensive support from the Commonwealth and State governments.
The project has been divided into three phases. The first is a two-month "run-in" phase. During this phase, all hospitals collected data on unplanned ICU admissions, cardiac arrest and deaths. During the latter half of this phase, randomisation occurred and half the hospitals were designated as control hospitals and the other half designated as intervention hospitals. The next phase was a four (4) month implementation stage. Control hospitals continued to collect data identical to that prior to the randomisation. The intervention hospitals also continued to collect the same data but a MET system was implemented in these hospitals.
Once this has been completed, the final stage or "study phase" commenced in 2003. This was a six (6) month process where the outcomes were compared between the two groups of hospitals.
Research nurses remained with the project until all relevant data for their hospitals were completed and/or data entry errors were corrected.
The project utilised scannable forms provided by the Simpson Centre for Health Services Research. All data was collected on the scannable forms, which were sent at regular intervals (weekly) from the participating centres to the Simpson Centre using pre-paid Australian Post envelopes. Numbers of forms sent and envelope identification numbers were placed on this WEB site so as to provide a quality assurance activity on the mailing of forms. The existing Australia Post tracking technology supported this. In order to derive the proper denominators of the incidence rates, the hospital inpatients data were extracted, cleaned and merged for all 23 hospitals. These data then were linked to the study specific data.

The MERIT study is a partnership between the Simpson Centre and the ANZICS Clinical Trial Groups http://www.anzics.com.au.
The steering committee members of the study are:

Professor Ken Hillman (Study Chairman)
Dr Simon Finfer (Study Vice-chairman)
Dr Rinaldo Bellomo
Dr Jack Chen
Dr Gordon Doig
Dr Arthas Flabouris
Dr Michael Parr
Dr Mike Buist
Dr Jenny Bartlett
Dr Michael Corkeron
Dr Sandra Peake
Dr John Santamaria

Current stage of the project and the publications

The MERIT project is at its end-stage currently after a very productive period since the end of the data collection at the end of 2004. The projects has so far generated more than 20 peer reviewed publications and book chapters with the landmark Lancet publication cited over 220 times (accessed in Nov. 2009). Currently, there are still several publications yet to be finished.

For more information on the MERIT Project, please contact:

Dr. Jack Chen MBBS PhD MBA
Senior Research Fellow

The Simpson Centre for Health Services Research
Australian Institute of Health Innovation
University of New South Wales

Tel: +61(2) 9612 0635 or +61(2) 9385 8895
Fax: +61(2) 9612 0745 or +61(2) 9385 8692
Email: jackchen@unsw.edu.au