From the *Department of Critical Care Medicine, University of Pittsburgh Medical Center, †Department of Critical Care Medicine, Critical Care Outreach Service, University of Pittsburgh Medical Center, and ‡Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Patient Saf. 2014 Jun;10(2):111-6. doi: 10.1097/PTS.0000000000000113.
The aim of this study was to determine the underlying characteristics of inpatients sustaining crisis events in the radiology department (RD).
This is a retrospective case series undertaken in a 715-bed university-based tertiary care referral center in the United States, with a well-established medical emergency response team (MET). Adult hospitalized inpatients sustaining crisis events in the radiology suites of the University of Pittsburgh Medical Center from November 1, 2008, to October 31, 2010, were reviewed.
Ninety-six MET activations met our criteria. There were 92 conditions classified as C. Four conditions were characterized as A, defined as cardiopulmonary arrest. Three condition C calls progressed to cardiopulmonary arrest and were reclassified as A. A number of variables including admission diagnosis, comorbid conditions, time elapsed from admission to condition, admission source of patient, unit of origin before event, and the type of imaging study ordered were analyzed to determine any links or patterns between precursor events, the likelihood of deterioration, and the patient's subsequent clinical outcome.Forty (42%) of the conditions occurred within 24 hours of admission, and 49 (51%) occurred within the first 48 hours. Forty-six of the studies ordered were computed tomographic scans. Of those patients who sustained their condition within the first 48 hours, 41 (84%) were either outside hospital transfers or emergency department admissions. A significant proportion of acute deteriorations occurred in patients with traumatic brain injuries or strokes. Ten events (10%) were due to radiology accidents.Irrespective of etiology, the intervention of the MET allowed the study to be completed in 68 (71%) cases. Of these, 28 (41%) had their condition diagnosed by the study. Of the 10 patients who sustained a radiology accident, no patients had an adverse effect to their outcome; all were returned to their unit of origin.
Inpatient deterioration in the RD often occurred early in the course of the patient's hospitalization, with more than 40% taking place in the first 24 hours of admission. The MET seemed to have a positive impact on many patients, allowing a substantial percentage of studies to be completed. Interpretation of those studies often identified the etiology of the deterioration. Further study of outside hospital transfers, emergency department admissions, and intensive care unit patients who deteriorate in the RD is warranted to clarify risk factors and to identify early signs of deterioration.
本研究旨在确定在放射科（RD）发生危机事件的住院患者的潜在特征。
这是在美国一家拥有 715 张床位的大学附属医院三级转诊中心进行的回顾性病例系列研究，该中心设有完善的医疗应急响应团队（MET）。对 2008 年 11 月 1 日至 2010 年 10 月 31 日期间在匹兹堡大学医学中心放射科套房发生危机事件的成年住院患者进行了回顾。
有 96 次 MET 激活符合我们的标准。有 92 种情况被归类为 C。4 种情况被定义为心肺骤停（A）。3 种 C 级呼叫进展为心肺骤停，并重新归类为 A。对包括入院诊断、合并症、从入院到病情发生的时间、患者入院来源、事件前的来源单位以及所下的影像学检查类型在内的多个变量进行了分析，以确定在前期事件、恶化的可能性和患者随后的临床结局之间是否存在联系或模式。40（42%）种情况发生在入院后 24 小时内，49（51%）种情况发生在入院后 48 小时内。所下的 46 项检查为计算机断层扫描。在那些在入院后 48 小时内发生病情的患者中，有 41（84%）人是从医院外转院或急诊入院。相当一部分急性恶化发生在创伤性脑损伤或中风患者中。10 起事件（10%）是由于放射科事故。无论病因如何，MET 的干预措施都使 68 例（71%）患者能够完成研究。其中，28 例（41%）通过研究确诊。在因放射科事故而住院的 10 名患者中，没有患者的治疗结果受到不利影响，他们都被送回了原发病区。
RD 中的住院患者病情恶化通常发生在住院过程的早期，超过 40%发生在入院后的前 24 小时内。MET 似乎对许多患者产生了积极影响，使相当一部分研究得以完成。对这些研究的解释通常确定了病情恶化的病因。进一步研究从医院外转院、急诊入院和在 RD 中恶化的重症监护病房患者，以明确危险因素并确定早期恶化迹象是有必要的。
