Lobos Anna-Theresa, Fernandes Rachel, Willams Kathyrn, Ramsay Christa, McNally James Dayre
1Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 2University of Ottawa, Ottawa, ON, Canada. 3Clinical Research Center, Boston Children's Hospital, Boston, MA. 4Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. 5Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
Pediatr Crit Care Med. 2015 May;16(4):359-65. doi: 10.1097/PCC.0000000000000354.
This study describes one follow-up program in the Ontario Rapid-Response System project consisting of routine medical emergency team visits of patients discharged from the PICU consisting of two planned visits within 48 hours following discharge. Study purpose was to describe interventions provided and the patient characteristics associated with medical emergency team utilization.
Retrospective cohort study.
Tertiary Pediatric Hospital, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Discharged pediatric patients from PICU.
Data over 41 months were obtained from a prospectively maintained rapid-response system database. Major medical emergency team support was defined as an early unplanned visit, intervention, or readmission during the follow-up period.
Interrupted time-series analysis comparing the 2 years preceding rapid-response system implementation with the subsequent 4 years demonstrated a statistically significant immediate change in PICU readmission rate (-5.5%, p = 0.0001). There were 1,805 patients followed after PICU discharge. During the 48-hour planned follow-up period, 4% of patients received an unplanned medical emergency team visit and 13% received an active intervention. Analysis of the first medical emergency team visit identified that 10% received major medical emergency team support. After the initial visit, 6% of patients received major medical emergency team support with predictive characteristics being an unplanned first visit (odds ratio, 3.7; 95% CI, 1.6-8.5) or an intervention during the first visit (odds ratio, 3.5; 95% CI, 2.1-5.8). Multiple diseased organs were associated with major medical emergency team support after the initial visit for recent surgical patients (odds ratio, 3.0 vs 1.2; p = 0.03).
Routine medical emergency team visits following PICU discharge reduced the risk of early readmission. Our results suggest that one in seven patients in the follow-up program receive major medical emergency team support. We suggest a follow-up program with at least one routine medical emergency team visit within the first 24 hours of discharge with a second planned visit reserved for complex postsurgical patients.
本研究描述了安大略快速反应系统项目中的一个随访计划，该计划包括对从儿科重症监护病房（PICU）出院的患者进行常规医疗急救团队访视，出院后48小时内安排两次访视。研究目的是描述所提供的干预措施以及与医疗急救团队使用相关的患者特征。
回顾性队列研究。
加拿大渥太华安大略东部儿童医院三级儿科医院。
从PICU出院的儿科患者。
从一个前瞻性维护的快速反应系统数据库中获取41个月的数据。主要医疗急救团队支持被定义为随访期间的早期非计划访视、干预或再次入院。
中断时间序列分析比较了快速反应系统实施前的2年与随后4年，结果显示PICU再入院率有统计学意义的即刻变化（-5.5%，p = 0.0001）。PICU出院后对1805名患者进行了随访。在48小时的计划随访期内，4%的患者接受了非计划的医疗急救团队访视，13%的患者接受了积极干预。对首次医疗急救团队访视的分析表明，10%的患者获得了主要医疗急救团队支持。首次访视后，6%的患者获得了主要医疗急救团队支持，预测特征为非计划的首次访视（比值比，3.7；95%置信区间，1.6 - 8.5）或首次访视期间的干预（比值比，3.5；95%置信区间，2.1 - 5.8）。对于近期手术患者，首次访视后多个患病器官与主要医疗急救团队支持相关（比值比，3.0对1.2；p = 0.03）。
PICU出院后进行常规医疗急救团队访视可降低早期再入院风险。我们的结果表明，随访计划中七分之一的患者获得了主要医疗急救团队支持。我们建议制定一个随访计划，在出院后的前24小时内至少进行一次常规医疗急救团队访视，并为复杂手术患者预留第二次计划访视。
