与引入针对病情恶化患者的两级应对措施相关的医院治疗结果。

Hospital outcomes associated with introduction of a two-tiered response to the deteriorating patient.

作者信息

Frost Steven A, Chapman Amanda, Aneman Anders, Chen Jack, Parr Michael J, Hillman Ken

机构信息

Intensive Care Liverpool Hospital, Sydney, NSW, Australia.

South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.

出版信息

Crit Care Resusc. 2015 Jun;17(2):77-82.

PMID:26017124

Abstract

BACKGROUND

Liverpool Hospital introduced the medical emergency team system in 1990 and it has recently been adopted at a national and international level. New South Wales, Australia, has introduced a standardised rapid response system in over 250 acutecare hospitals: the two-tiered (clinical review call [CRC] and rapid response call [RRC]) "between the flags" (BTF) program.

OBJECTIVES

To describe the effect of the introduction of a twotiered response to the deteriorating patient on the number of RRCs, cardiac arrests and hospital deaths.

METHODS

Our study was undertaken at an 850-bed teaching hospital in the south-west of Sydney, Australia, with about 80 000 hospital admissions each year. Rates of RRCs, cardiac arrests and all hospital deaths (with and without not-for-resuscitation orders) were compared before the introduction of the BTF program (2009) and after implementation, until June 2013. The rates of CRCs after implementation were measured. Changes in the reasons for RRCs were also compared for the 12-month period before and the 36 months after the introduction of the BTF program.

RESULTS

The monthly rate of RRCs before introduction of the program was 18.8 per 1000 hospital admissions (95% CI, 17.8- 19.8 per 1000 admissions) and was estimated to increase by 4% after program implementation (95% CI, 3.2%-4.7%; P < 0.001). The rate of CRCs increased by 13.2% (95% CI, 10.9%-15.6%) during the study period. The cardiac arrest rate before implementation of clinical review was 1.1 per 1000 admissions (95% CI, 0.9-1.3 per 1000 admissions) and after implementation was estimated to have changed by 1% (95% CI, - 1.9 to 3.9; P = 0.48). The hospital death rate before implementation of the BTF program was 10.8 per 1000 admissions (95% CI, 10.1-11.5 per 1000 admissions), and after implementation was estimated to increase by 2% (95% CI, 1.2%-3%, P < 0.001). The reasons for RRCs before and after the introduction of the BTF program did not change (all P values > 0.2), apart from the "worried" criterion, that decreased from 30% to 17% of all calls after implementation (P < 0.001).

CONCLUSION

After introduction of the BTF program, there was a progressive increase in documented CRCs and an increase in RRCs. There was no decrease in cardiac arrests or hospital deaths. RRCs based on objective physiological criteria increased. More research is needed to evaluate two-tiered response systems.

摘要

背景

利物浦医院于1990年引入了医疗急救团队系统，该系统最近已在国家和国际层面得到采用。澳大利亚新南威尔士州已在250多家急性护理医院引入了标准化的快速反应系统：两层级（临床评估呼叫[CRC]和快速反应呼叫[RRC]）的“旗帜之间”（BTF）计划。

目的

描述对病情恶化患者引入两层级反应措施对快速反应呼叫次数、心脏骤停次数和医院死亡人数的影响。

方法

我们的研究在澳大利亚悉尼西南部一家拥有850张床位的教学医院进行，每年约有80000例住院患者。比较了BTF计划引入前（2009年）和实施后直至2013年6月期间的快速反应呼叫率、心脏骤停率和所有医院死亡人数（包括有和没有不进行心肺复苏医嘱的情况）。测量了实施后的临床评估呼叫率。还比较了BTF计划引入前12个月和引入后36个月期间快速反应呼叫原因的变化。

结果

该计划引入前，快速反应呼叫的月发生率为每1000例住院患者18.8次（95%置信区间，每1000例住院患者17.8 - 19.8次），预计计划实施后将增加4%（95%置信区间，3.2% - 4.7%；P < 0.001）。在研究期间，临床评估呼叫率增加了13.2%（95%置信区间，10.9% - 15.6%）。临床评估实施前，心脏骤停率为每1000例住院患者1.1次（95%置信区间，每1000例住院患者0.9 - 1.3次），实施后估计变化了1%（95%置信区间，-1.9至3.9；P = 0.48）。BTF计划实施前，医院死亡率为每1000例住院患者10.8例（95%置信区间，每1000例住院患者10.1 - 11.5例），实施后估计增加了2%（95%置信区间，1.2% - 3%，P < 0.001）。除了“担忧”标准外，BTF计划引入前后快速反应呼叫的原因没有变化（所有P值>0.2），该标准在实施后从所有呼叫的30%降至17%（P < 0.001）。