459 August 2006 Volume 32 Number 8 I n this article, we present a case of a 26-year-old woman who underwent an ultrasound-guided per- cutaneous liver biopsy. She suffered severe hemor- rhage shortly after the procedure and required a laparotomy and oversewing of a bleeding vessel. At 3 A.M. the following morning, she developed further bleeding and underwent angiographic embolization of the culprit vessel. The 24-hour availability of the medical emergency team (MET) and its role in coordinating patient care on both episodes of bleeding is discussed. Setting The Alfred Hospital is a 350-bed tertiary-referral center affiliated with Monash University in Melbourne, Australia. The hospital provides a wide variety of medical and surgical services, including cardiothoracic and neu- rosurgery. Moreover, it contains the primary trauma and burns units for the state of Victoria, as well as units for bone marrow, lung, and heart transplantation. The inten- sive care unit (ICU), which contains an average of 30 beds, services a mixed trauma, medical, and surgical pop- ulation. The ICU operates according to a “closed model,” in which only intensive care staff can prescribe therapy. Overview of the Hospital’s Rapid Response Systems The evolution of the rapid response systems at the Alfred Hospital has been explained in detail previously. 1 Since October 2004, the rapid response systems have consisted of a separate cardiac arrest team and a med- ical emergency team (MET) service. The cardiac arrest team is activated by hospital staff via the hospital switchboard using overhead chimes, an announcement, and serial pages to the team members. It consists of an ICU nurse as well as fellows from the departments of anaesthesia, cardiology, intensive care, and internal medicine. The MET consists of an ICU fellow and nurse, as well as an internal medicine fellow. It can be activated by any member of hospital staff in response to changes in com- monly measured vital signs. Specifically, the criteria involve changes in heart rate (40 < HR > 140 bpm), systolic blood pressure ([SBP] < 90 mmHg), respiratory rate (8 < RR > 36 breaths per minute), altered conscious state, and oxygen saturations (SaO 2 < 90% despite oxy- gen). In addition, there exists a “worried” criterion to allow staff to activate the MET for any other reason. Activation of the MET occurs via an announcement on the overhead public announcement system and by a group-paging message to the team members. During office hours (8:00 A.M. to 5:00 P.M.) a senior ICU fellow is allocated to review new ICU referrals and MET calls. Overnight MET calls require attendance by the covering senior ICU fellow. During this period, the ICU is staffed by junior ICU fellows, and the senior ICU fellow can be reached at all times. Using an MET Service to Manage Hemorrhage Post-Percutaneous Liver Biopsy Rapid Response Systems: The Stories Daryl Jones, M.D. Rinaldo Bellomo, M.D. Tim Leong, M.D. Series Editors: Michael A. DeVita, M.D., Rinaldo Bellomo, M.D., Kenneth Hillman, M.D. Readers are invited to submit inquiries regarding their own case studies on rapid response systems to Steven Berman (sberman@jcaho.org) or Michael A. DeVita (devitam@upmc.edu). Copyright 2006 Joint Commission on Accreditation of Healthcare Organizations