Department of Intensive Care Unit, St. Vincent's Hospital, Melbourne, Australia.
Crit Care Med. 2010 Feb;38(2):445-50. doi: 10.1097/CCM.0b013e3181cb0ff1.
To determine the long-term impact of a medical emergency team on survival and to assess the utility of administrative data to monitor outcomes.
Prospective study of cardiac arrests and survival. Retrospective study of administrative data.
University affiliated tertiary referral hospital in Melbourne, Australia.
All patients admitted to hospital in three 6-month periods between 2002-2007 (prospective) and 1993-2007 (retrospective).
Implementation of a medical emergency team in November 2002.
In the prospective analysis, rates of unexpected cardiac arrest and hospital mortality (referenced to 1000 patient-care days) were measured before (July-August 2002) and after (December 2002-May 2003, December 2004-May 2005, December 2006-May 2007) the introduction of the medical emergency team. Cardiac arrest rates decreased progressively from 0.78 per 1000 (95% confidence interval, 0.50-1.16) to 0.25 per 1000 (95% confidence interval, 0.15-0.39, p < .001), and hospital mortality from 0.58 per 1000 (95% confidence interval, 0.35-0.92) to 0.30 per 1000 (95% confidence interval, 0.20-0.46, p < .05); cardiac arrest rates achieved statistical significance at 2 yrs and hospital mortality at 4 yrs. Using administrative data adjusted for age, sex, case-mix, and comorbidity, hazard ratios for mortality for the three post implementation periods were statistically lower than for the 10 yrs pre implementation (0.85, 0.74, 0.65). The intensity of calling (calls/1000 patient-days) inversely correlated with cardiac arrest rate, unexpected mortality rate, and total hospital mortality rate.
The introduction of a medical emergency team was associated with a progressive decline of unexpected cardiac arrests within 2 yrs, and of unexpected mortality within 4 yrs. This suggests that changes to organizational practice take time and benefits may not be immediately obvious. Such changes are reflected in total hospital mortality measured from administrative data and make monitoring simpler in the longer term. Finally, efforts to increase calling of emergency teams should reduce cardiac arrests and mortality.
确定医疗急救小组对生存率的长期影响，并评估行政数据在监测结果方面的实用性。
心脏骤停和生存率的前瞻性研究。行政数据的回顾性研究。
澳大利亚墨尔本的一所大学附属医院。
2002-2007 年三个 6 个月期间入院的所有患者（前瞻性）和 1993-2007 年（回顾性）。
2002 年 11 月实施医疗急救小组。
在前瞻性分析中，在引入医疗急救小组之前（2002 年 7-8 月）和之后（2002 年 12 月至 2003 年 5 月，2004 年 12 月至 2005 年 5 月，2006 年 12 月至 2007 年 5 月），测量意外心脏骤停和医院死亡率（以每 1000 名患者护理日为参考）的发生率。心脏骤停率从每 1000 名 0.78（95%置信区间，0.50-1.16）逐渐降至每 1000 名 0.25（95%置信区间，0.15-0.39，p<.001），医院死亡率从每 1000 名 0.58（95%置信区间，0.35-0.92）降至每 1000 名 0.30（95%置信区间，0.20-0.46，p<.05）；心脏骤停率在 2 年内达到统计学意义，医院死亡率在 4 年内达到统计学意义。使用调整年龄、性别、病例组合和合并症的行政数据，实施后三个时期的死亡率风险比均低于实施前 10 年（0.85、0.74、0.65）。呼叫强度（每 1000 名患者呼叫次数）与心脏骤停率、意外死亡率和总医院死亡率呈反比。
引入医疗急救小组与 2 年内意外心脏骤停的逐渐减少以及 4 年内意外死亡率的降低有关。这表明组织实践的改变需要时间，并且好处可能不会立即显现。这些变化反映在行政数据测量的总医院死亡率中，并使长期监测更加简单。最后，增加急救小组呼叫的努力应该可以减少心脏骤停和死亡率。
