Galhotra Sanjay, DeVita Michael A, Simmons Richard L, Dew Mary Amanda
University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Qual Saf Health Care. 2007 Aug;16(4):260-5. doi: 10.1136/qshc.2007.022210.
To study the incidence, outcome and potentially avoidable causes of inpatient cardiopulmonary arrests in a hospital with a "mature" rapid response system (RRS).
Retrospective observational study of all cardiopulmonary arrest events in 2005.
University of Pittsburgh Medical Center Presbyterian Hospital, a 730-bed academic, urban, tertiary care adult hospital in the USA.
None.
During the calendar year 2005, the 16th year since the establishment of a medical emergency team (MET)/RRS, the MET was activated 1942 times; 111 of these events were cardiopulmonary arrest events (3.26 arrest events/1000 patient admissions), and 1831 were non-arrest patient crisis events (53.8 crisis events/1000 patient admissions). A review of the 104 index cardiopulmonary arrest events revealed that 26 (25%) patients survived to discharge. Event survival decreased as the intensity of patient monitoring decreased (83% in intensive care units, 69% in monitored, and 36% in unmonitored units; p = 0.002), but the rate of subsequent in-hospital death was higher in the more intensely monitored settings (60%, 38%, 23%, respectively; p = 0.022). Nineteen (18%) arrests were deemed to be "potentially avoidable". Avoidable arrests were classified as: failure to adhere to established hospital patient care guideline or policy; inadequate monitoring or surveillance; or delays in dealing with patient needs including delay in MET/RRS activation.
In spite of the high crisis event rate and a low rate of cardiac arrests, potentially avoidable cardiopulmonary arrests still occurred. According to the present study more cardiopulmonary arrest events might be avoided by better adherence to hospital patient care policies, by closer monitoring on floors and by preventing delays in addressing deterioration in patient condition.
在一家拥有“成熟”快速反应系统（RRS）的医院中，研究住院患者心肺骤停的发生率、转归及潜在可避免的原因。
对2005年所有心肺骤停事件进行回顾性观察研究。
美国匹兹堡大学医学中心长老会医院，一家拥有730张床位的学术性城市三级成人护理医院。
无。
在2005日历年，即医疗急救团队（MET）/RRS成立后的第16年，MET被激活1942次；其中111次事件为心肺骤停事件（3.26次骤停事件/1000例患者入院），1831次为非骤停患者危机事件（53.8次危机事件/1000例患者入院）。对104例索引心肺骤停事件的回顾显示，26例（25%）患者存活至出院。随着患者监测强度降低，事件存活率下降（重症监护病房为83%，监测病房为69%，未监测病房为36%；p = 0.002），但在监测更严密的环境中，随后的院内死亡率更高（分别为60%、38%、23%；p = 0.022）。19例（18%）骤停被认为是“潜在可避免的”。可避免的骤停被分类为：未遵守既定的医院患者护理指南或政策；监测或监督不足；或处理患者需求的延迟，包括MET/RRS激活延迟。
尽管危机事件发生率高且心脏骤停发生率低，但仍发生了潜在可避免的心肺骤停。根据本研究，通过更好地遵守医院患者护理政策、加强病房监测以及防止处理患者病情恶化的延迟，可能避免更多的心肺骤停事件。
