与荷兰全国范围内快速反应系统的引入相关的结果。

Outcomes Associated With the Nationwide Introduction of Rapid Response Systems in The Netherlands.

机构信息

1Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands. 2Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands. 3Department of Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands. 4Department of Geriatric Rehabilitation and Transmural Care, Cordaan, Amsterdam, The Netherlands. 5Department of Geriatrics, Academic Medical Center, Amsterdam, The Netherlands. 6Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. 7Department of Educational Support, Academic Medical Center, Amsterdam, The Netherlands. 8Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands. 9Department of Intensive Care, Reinier de Graaf Hospital, Delft, The Netherlands.

出版信息

Crit Care Med. 2015 Dec;43(12):2544-51. doi: 10.1097/CCM.0000000000001272.

DOI:10.1097/CCM.0000000000001272

PMID:26317569

Abstract

OBJECTIVE

To describe the effect of implementation of a rapid response system on the composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death.

DESIGN

Pragmatic prospective Dutch multicenter before-after trial, Cost and Outcomes analysis of Medical Emergency Teams trial.

SETTING

Twelve hospitals participated, each including two surgical and two nonsurgical wards between April 2009 and November 2011. The Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments were implemented over 7 months. The rapid response team was then implemented during the following 17 months. The effects of implementing the rapid response team were measured in the last 5 months of this period.

PATIENTS

All patients 18 years old and older admitted to the study wards were included.

MEASUREMENTS AND MAIN RESULTS

In total, 166,569 patients were included in the study representing 1,031,172 hospital admission days. No differences were observed in patient demographics between periods. The composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death per 1,000 admissions was significantly reduced in the rapid response team versus the before phase (adjusted odds ratio, 0.847; 95% CI, 0.725-0.989; p = 0.036). Cardiopulmonary arrests and in-hospital mortality were also significantly reduced (odds ratio, 0.607; 95% CI, 0.393-0.937; p = 0.018 and odds ratio, 0.802; 95% CI, 0.644-1.0; p = 0.05, respectively). Unplanned ICU admissions showed a declining trend (odds ratio, 0.878; 95% CI, 0.755-1.021; p = 0.092), whereas severity of illness at the moment of ICU admission was not different between periods.

CONCLUSIONS

In this study, introduction of nationwide implementation of rapid response systems was associated with a decrease in the composite endpoint of cardiopulmonary arrests, unplanned ICU admissions, and mortality in patients in general hospital wards. These findings support the implementation of rapid response systems in hospitals to reduce severe adverse events.

摘要

目的

描述快速反应系统实施对心肺骤停、非计划性 ICU 入院或死亡的复合终点的影响。

设计

荷兰多中心实用前瞻性前后试验，医疗急救团队成本和结果分析试验。

地点

12 家医院参与，每家医院包括 2 个外科病房和 2 个非外科病房，时间为 2009 年 4 月至 2011 年 11 月。在 7 个月期间实施改良早期预警评分和情况-背景-评估-建议工具。快速反应团队在接下来的 17 个月中实施。在这段时间的最后 5 个月里，测量了快速反应团队的效果。

患者

纳入研究病房 18 岁及以上的所有患者。

测量和主要结果

共纳入 166569 例患者，代表 1031112 例住院日。两个阶段患者的人口统计学特征无差异。每 1000 例入院患者的心肺骤停、非计划性 ICU 入院或死亡的复合终点在快速反应团队与前阶段相比显著降低（调整后的优势比，0.847；95%可信区间，0.725-0.989；p=0.036）。心肺骤停和院内死亡率也显著降低（优势比，0.607；95%可信区间，0.393-0.937；p=0.018 和优势比，0.802；95%可信区间，0.644-1.0；p=0.05）。非计划性 ICU 入院呈下降趋势（优势比，0.878；95%可信区间，0.755-1.021；p=0.092），而 ICU 入院时的疾病严重程度在两个阶段无差异。