... single-centre data[52-56]. Inherent within this type of evidence is the lack of rigour and generalisability. Furthermore, the magnitude of the effect of the MET may be influenced by institution-specificadministrative ... However, in an era of ‘evidence-based medicine’, the efficacy of the MET and utility of the RRS have been criticised for lacking sufficient high-qualityevidence in the form of randomised controlled ... assessment of such systemsflawed and non-representative of their later performance[29,34]. Accordingly, the challenges surrounding the imple-mentation of such systems require detailed discussion.The...