Jones Daryl, George Carol, Hart Graeme K, Bellomo Rinaldo, Martin Jacqueline
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, 89 Commercial Road, Melbourne 3004, Victoria, Australia.
Crit Care. 2008;12(2):R46. doi: 10.1186/cc6857. Epub 2008 Apr 7.
Information about Medical Emergency Teams (METs) in Australia and New Zealand (ANZ) is limited to local studies and a cluster randomised controlled trial (the Medical Emergency Response and Intervention Trial [MERIT]). Thus, we sought to describe the timing of the introduction of METs into ANZ hospitals relative to relevant publications and to assess changes in the incidence and rate of intensive care unit (ICU) admissions due to a ward cardiac arrest (CA) and ICU readmissions.
We used the Australian and New Zealand Intensive Care Society database to obtain the study data. We related MET introduction to publications about adverse events and MET services. We compared the incidence and rate of readmissions and admitted CAs from wards before and after the introduction of an MET. Finally, we identified hospitals without an MET system which had contributed to the database for at least two years from 2002 to 2005 and measured the incidence of adverse events from the first year of contribution to the second.
The MET status was known for 131 of the 172 (76.2%) hospitals that did not participate in the MERIT study. Among these hospitals, 110 (64.1%) had introduced an MET service by 2005. In the 79 hospitals in which the MET commencement date was known, 75% had introduced an MET by May 2002. Of the 110 hospitals in which an MET service was introduced, 24 (21.8%) contributed continuous data in the year before and after the known commencement date. In these hospitals, the mean incidence of CAs admitted to the ICU from the wards changed from 6.33 per year before to 5.04 per year in the year after the MET service began (difference of 1.29 per year, 95% confidence interval [CI] -0.09 to 2.67; P = 0.0244). The incidence of ICU readmissions and the mortality for both ICU-admitted CAs from wards and ICU readmissions did not change. Data were available to calculate the change in ICU admissions due to ward CAs for 16 of 62 (25.8%) hospitals without an MET system. In these hospitals, admissions to the ICU after a ward CA decreased from 5.0 per year in the first year of data contribution to 4.2 per year in the following year (difference of 0.8 per year, 95% CI -0.81 to 3.49; P = 0.3).
Approximately 60% of hospitals in ANZ with an ICU report having an MET service. Most introduced the MET service early and in association with literature related to adverse events. Although available in only a quarter of hospitals, temporal trends suggest an overall decrease in the incidence of ward CAs admitted to the ICU in MET as well as non-MET hospitals.
关于澳大利亚和新西兰（澳新）医疗应急小组（METs）的信息仅限于当地研究和一项整群随机对照试验（医疗应急响应与干预试验[MERIT]）。因此，我们试图描述澳新医院引入METs的时间相对于相关出版物的情况，并评估因病房心脏骤停（CA）导致的重症监护病房（ICU）入院率和再入院率的变化。
我们使用澳大利亚和新西兰重症监护学会数据库获取研究数据。我们将METs的引入与关于不良事件和MET服务的出版物相关联。我们比较了引入METs前后病房再入院率和CA入院率。最后，我们确定了在2002年至2005年期间至少为该数据库贡献数据两年的没有MET系统的医院，并测量了从贡献数据的第一年到第二年不良事件的发生率。
在172家未参与MERIT研究的医院中，有131家（76.2%）的METs状况已知。在这些医院中，到2005年有110家（64.1%）引入了MET服务。在已知MET开始日期的79家医院中，75%在2002年5月前引入了MET。在引入MET服务的110家医院中，有24家（21.8%）在已知开始日期的前一年和后一年提供了连续数据。在这些医院中，从病房收治到ICU的CA的平均发生率从MET服务开始前的每年6.33例降至服务开始后的每年5.04例（每年相差1.29例，95%置信区间[CI] -0.09至2.67；P = 0.0244）。ICU再入院率以及病房CA收治到ICU和ICU再入院的死亡率均未改变。对于62家（25.8%）没有MET系统的医院中的16家，有数据可用于计算因病房CA导致的ICU入院率的变化。在这些医院中，病房CA后入住ICU的人数从数据贡献的第一年的每年5.0例降至次年的每年4.2例（每年相差0.8例，95% CI -0.81至3.49；P = 0.3）。
澳新地区约60%设有ICU的医院报告有MET服务。大多数医院早期引入了MET服务，且与不良事件相关文献有关。虽然仅四分之一的医院有相关数据，但时间趋势表明，MET医院和非MET医院中，病房CA收治到ICU的发生率总体呈下降趋势。
