Simpson Centre for Health Services Research, University of New South Wales, Sydney, New South Wales, Australia.
J Crit Care. 2010 Jun;25(2):359.e1-7. doi: 10.1016/j.jcrc.2009.12.011. Epub 2010 Mar 1.
The purpose of the study was to examine triggers for emergency team activation in hospitals with or without a medical emergency team (MET) system.
Within a cluster randomized controlled trial examining the effect of introducing a MET system, we recorded the triggers for emergency team activation. We compared the proportion and rate of such triggers in hospitals with or without a MET system and in relation to type of hospital, type of patient ward, and time of day.
In control hospitals, the most common trigger for emergency team activation was a decrease in Glasgow Coma Score by 2 or more points (45.6%), whereas in MET hospitals, it was the fact that staff members were "worried" or the call occurred despite the lack of a "specified reason" (39.3%). In particular, MET hospitals were 35 times more likely to make a call because of staff being "worried" about the patient (14.1% vs 0.4%, P < .001). Control hospitals were also significantly more likely to call an emergency team because of a deteriorating respiratory (P = .003) or pulse (P < .001) rate, more calls had at least 3 triggers for activation (20.8% vs 10.2%, P = .036), and the average number of triggers per call was significantly higher (P = .013). Nonmetropolitan hospitals were more likely to call an emergency team because of respiratory rate abnormalities (33.6% vs 23.2%, P = .015). Coronary care unit calls were more likely to be triggered by abnormalities in pulse rate and systolic blood pressure, and more calls occurred during the period from 6:00 am to noon.
In MET hospitals, more emergency team calls are triggered because staff members are worried about the patient; and fewer calls have multiple triggers. Type of hospital, type of ward, and time of day also affect the nature and frequency of triggers for emergency team activation.
本研究旨在探讨有无医疗急救团队（MET）系统的医院中，急诊团队激活的触发因素。
在一项评估引入 MET 系统效果的整群随机对照试验中，我们记录了急诊团队激活的触发因素。我们比较了有无 MET 系统的医院、不同类型的患者病房以及不同时间段的触发因素的比例和速率。
在对照组医院，急诊团队激活的最常见触发因素是格拉斯哥昏迷评分下降 2 分或以上（45.6%），而在 MET 组医院，触发因素是医护人员“担心”或即使没有“指定原因”也打电话（39.3%）。特别是，由于医护人员担心患者，MET 医院打电话的可能性高 35 倍（14.1%比 0.4%，P<.001）。对照组医院因呼吸（P=.003）或脉搏（P<.001）率恶化而呼叫急救团队的可能性也显著更高，至少有 3 个触发因素的呼叫更多（20.8%比 10.2%，P=.036），每次呼叫的平均触发因素数量也明显更高（P=.013）。非都市地区医院因呼吸率异常而呼叫急救团队的可能性更高（33.6%比 23.2%，P=.015）。冠心病监护病房的呼叫更可能由脉搏率和收缩压异常引起，并且更多的呼叫发生在上午 6 点到中午这段时间。
在 MET 医院，更多的急救团队呼叫是因为医护人员担心患者，而且更少的呼叫有多个触发因素。医院类型、病房类型和一天中的时间也会影响急诊团队激活的触发因素的性质和频率。
