Barriers and facilitators to Medical Emergency Team activation among healthcare professionals: protocol for a multicentre cross-sectional survey in four Swiss hospitals

Background: Medical Emergency Teams (METs) are intended to provide early expert assessment and treatment for deteriorating hospitalised patients. However, MET activation may occur only after prolonged physiological deterioration. Potential explanations include uncertainty about activation criteria, professional hierarchy, departmental culture, perceived pressure to manage deterioration without help, fear of criticism, and concerns that activation may reflect poorly on professional competence. This study aims to identify modifiable barriers and facilitators to timely MET activation among healthcare professionals caring for hospitalised adults. Methods: This multicentre cross-sectional web survey will be conducted sequentially at four Swiss hospitals: two cantonal hospitals and two tertiary university hospitals. Eligible participants are physicians, nurses, nurses in training, physiotherapists, occupational therapists, and speech and language therapists involved in the care of hospitalised adult patients in areas where MET activation may occur. Staff working primarily in paediatrics, emergency medicine, anaesthesia, intensive care, operating theatres, recovery areas, or outpatient care, and MET members themselves, are excluded. The German-language questionnaire was developed from relevant items identified in published MET and rapid response system surveys and was informed by the revised 14-domain Theoretical Domains Framework (TDF). The TDF was used to assess the theoretical breadth of the candidate item pool and to ensure coverage of all domains judged relevant to timely MET activation. Two physician investigators independently mapped candidate items to the single TDF domain judged most appropriate; disagreements were resolved by consensus. All 14 TDF(v2) domains were judged potentially relevant to the target behaviour, and additional items were developed when relevant domains were not adequately represented. The questionnaire was pilot tested by physicians and nurses. The four prespecified primary outcomes comprise one proximal self-reported behavioural indicator - non-activation despite fulfilment of MET criteria - and three potential determinants of timely activation: perceived pressure to avoid activation, concern that activation may reflect poorly on professional competence, and absence of a departmental culture supporting immediate activation. These outcomes were specified in the protocol and statistical analysis plan before inspection of the pooled multicentre results. The primary professional comparison is physicians versus nurses. Ordinal logistic regression will adjust for hospital, years of professional experience, clinical area, and previous personal MET activation. Secondary outcomes will be analysed descriptively and exploratorily. No comparison by MET maturity will be undertaken. Ethics and dissemination: The project was classified as research outside the scope of the Swiss Human Research Act. Site-specific ethics determinations and institutional endorsements will be reported. Participation is voluntary. Responses are confidential rather than fully anonymous because optional contact details may be entered in the same survey record. Results will be disseminated through a peer-reviewed publication, presentations, and aggregated feedback to participating hospitals. Registration: Because data collection has already been completed at one hospital, the registration will be described as a prospective registration of the pooled analysis rather than a fully prospective preregistration.