Department of Internal Medicine, Division of Cardiovascular Diseases, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242-1081, USA.
Acad Med. 2011 Jun;86(6):726-30. doi: 10.1097/ACM.0b013e318217e44e.
Emergency resuscitation or "code blue" is a clinical event through which responding medical residents gain experience and proficiency. A retooling of practice has occurred at academic medical centers since the emergence of quality improvement initiatives and resident duty hours limits. The authors investigated how these changes may impact code blue frequency and resident opportunities to gain clinical experience.
The authors conducted a single-center, retrospective (2002-2009) review of monthly code blue frequency. They compared code blue frequency with corresponding monthly first-year internal medicine resident call schedules (2002-2008 academic years). Using a Monte Carlo simulation they estimated annual code blue experience, and using Poisson regression, they estimated annual trends in resident code blue experience.
The authors detected a 41% overall reduction in code blue events between 2002 and 2008; code blue events decreased by 13% annually (P < .001). These trends persisted, even after accounting for hospital census fluctuations: Rates fell from approximately 12 code blue events/1,000 admissions in 2002 to 3.8 events/1,000 in 2008. Overall, the model of code blue frequency and resident call schedules shows a dramatic reduction in the predicted number of code blue experiences, falling from 29 events (empirical 95% CI 18-40) in academic year 2002 to 5 events (CI 1-9) in 2008.
Physicians-in-training at one facility are seeing far fewer code blue events than their predecessors. Whether current numbers of in-hospital code blue events are sufficient to provide adequate experience without supplemental practice for trainees is unclear.
急救复苏或“抢救”是一个临床事件，通过这个事件，实习住院医师获得经验和熟练度。自从质量改进倡议和住院医师值班时间限制出现以来，学术医疗中心已经对实践进行了调整。作者研究了这些变化如何影响抢救的频率和住院医师获得临床经验的机会。
作者对单中心 2002 年至 2009 年每月抢救的频率进行了回顾性研究。他们将抢救的频率与同期每月第一年内科住院医师的值班时间表（2002-2008 学年）进行了比较。作者使用蒙特卡罗模拟来估计每年的抢救经验，使用泊松回归来估计住院医师每年抢救经验的趋势。
作者发现，2002 年至 2008 年期间，抢救事件总数减少了 41%；抢救事件每年减少 13%（P <.001）。即使考虑到医院的人口波动，这些趋势仍然存在：在 2002 年，每 1000 次入院有 12 次抢救事件，到 2008 年下降到 3.8 次。总的来说，抢救频率和住院医师值班时间表的模型显示，抢救经验的预测数量显著减少，从 2002 学年的 29 次（经验 95%置信区间 18-40）下降到 2008 年的 5 次（置信区间 1-9）。
一个医疗机构的实习住院医师看到的抢救事件比他们的前辈少得多。目前院内抢救事件的数量是否足以让住院医师在没有额外实践的情况下获得足够的经验，目前还不清楚。
