Department of Intensive Care, Austin Health, Melbourne, Australia.
Crit Care Med. 2012 Aug;40(8):2349-61. doi: 10.1097/CCM.0b013e318255d9a0.
Deteriorating ward patients are at increased risk. Electronic automated advisory vital signs monitors may help identify such patients and improve their outcomes.
A total of 349 beds, in 12 general wards in ten hospitals in the United States, Europe, and Australia.
Cohort of 18,305 patients.
Before-and-after controlled trial.
We deployed electronic automated advisory vital signs monitors to assist in the acquisition of vital signs and calculation of early warning scores. We assessed their effect on frequency, type, and treatment of rapid response team calls; survival to hospital discharge or to 90 days for rapid response team call patients; overall type and number of serious adverse events and length of hospital stay.
We studied 9,617 patients before (control) and 8,688 after (intervention) deployment of electronic automated advisory vital signs monitors. Among rapid response team call patients, intervention was associated with an increased proportion of calls secondary to abnormal respiratory vital signs (from 21% to 31%; difference [95% confidence interval] 9.9 [0.1-18.5]; p=.029). Survival immediately after rapid response team treatment and survival to hospital discharge or 90 days increased from 86% to 92% (difference [95% confidence interval] 6.3 [0.0-12.6]; p=.04). Intervention was also associated with a decrease in median length of hospital stay in all patients (unadjusted p<.0001; adjusted p=.09) and more so in U.S. patients (from 3.4 to 3.0 days; unadjusted p<.0001; adjusted ratio [95% confidence interval] 1.03 [1.00-1.06]; p=.026). The time required to complete and record a set of vital signs decreased from 4.1±1.3 mins to 2.5±0.5 mins (difference [95% confidence interval] 1.6 [1.4-1.8]; p<.0001).
Deployment of electronic automated advisory vital signs monitors was associated with an improvement in the proportion of rapid response team-calls triggered by respiratory criteria, increased survival of patients receiving rapid response team calls, and decreased time required for vital signs measurement and recording (NCT01197326).
病情恶化的住院患者风险增加。电子自动警示生命体征监测仪有助于识别此类患者并改善其预后。
美国、欧洲和澳大利亚 10 家医院的 12 个普通病房共 349 张床位。
共纳入 18305 例患者。
前后对照试验。
我们部署了电子自动警示生命体征监测仪以辅助获取生命体征和计算早期预警评分。我们评估了其对快速反应团队呼叫的频率、类型和治疗的影响；快速反应团队呼叫患者的存活率至出院或 90 天；总体严重不良事件的类型和数量以及住院时间。
我们在电子自动警示生命体征监测仪部署前（对照组）和后（干预组）分别研究了 9617 例和 8688 例患者。在快速反应团队呼叫患者中，干预与因呼吸生命体征异常而导致的呼叫比例增加有关（从 21%增加到 31%；差值[95%置信区间]为 9.9[0.1-18.5]；p=.029）。快速反应团队治疗后即刻和出院或 90 天的存活率从 86%增加到 92%（差值[95%置信区间]为 6.3[0.0-12.6]；p=.04）。干预还与所有患者的中位住院时间缩短相关（未经调整 p<.0001；调整后 p=.09），美国患者更为显著（从 3.4 天降至 3.0 天；未经调整 p<.0001；调整后比值[95%置信区间]为 1.03[1.00-1.06]；p=.026）。完成和记录一组生命体征所需的时间从 4.1±1.3 分钟减少到 2.5±0.5 分钟（差值[95%置信区间]为 1.6[1.4-1.8]；p<.0001）。
电子自动警示生命体征监测仪的部署与呼吸标准触发的快速反应团队呼叫比例提高、接受快速反应团队呼叫患者的存活率提高以及生命体征测量和记录所需时间减少有关（NCT01197326）。
