Alfred Hospital, Melbourne, Victoria, Australia.
Western Health, Victoria, Australia.
Aust Crit Care. 2018 Jul;31(4):219-225. doi: 10.1016/j.aucc.2017.05.002. Epub 2017 Jul 19.
This study had three main aims. Develop a methodology for reviewing in-hospital cardiac arrests (IHCA). Assess appropriateness and potential preventability of IHCAs. Identify areas for improvement within the rapid response system (RRS).
A retrospective cohort study of IHCA identified from an existing organisational electronic database of medical emergency (MET) and Code Blue team activation. Potential preventability of IHCA and Code Blue team activation were established by an expert panel based on a standardised case review process with descriptive and content analyses for each IHCA event.
A university affiliated tertiary referral hospital with an established two-tier RRS in Melbourne, Australia.
Same day and multi-day stay patients identified from an existing database as having an IHCA defined as attempted resuscitation with chest compressions, defibrillation, or both from January 2014 to December 2015.
Outcome measures were: number of Code Blue activations; potential preventability of Code Blue activations and potential preventability of the IHCA event.
A total of 120 IHCA events equating to 0.58 per 1000 total admissions occurred. 11 (9%) of IHCA were determined to be potentially preventable due to a failure to escalate, medication errors and inappropriate management. 39 (33%) of 120 Code Blue team activations were determined to be potentially preventable. These were typically due to lack of identification and documentation for end of life (EOL) care in 16 (62%) cases and inappropriate resuscitation when limitations of care were already in place in 10 (38%) cases.
The study centre has a comparably low rate of preventable IHCA which could be reduced further through improvements in documentation and handover process. A focus on improved communication, recognition and earlier instigation of appropriate EOL care will reduce this rate further.
本研究有三个主要目的。开发一种审查院内心搏骤停（IHCA）的方法。评估 IHCA 和医疗急救（MET）及 Code Blue 团队激活的适当性和潜在可预防性。确定快速反应系统（RRS）内的改进领域。
一项回顾性队列研究，从现有的医疗紧急事件（MET）和 Code Blue 团队激活的组织电子数据库中确定 IHCA。根据标准案例审查过程，由专家小组确定 IHCA 和 Code Blue 团队激活的潜在可预防性，并对每个 IHCA 事件进行描述性和内容分析。
澳大利亚墨尔本一家附属大学附属医院，设有两级快速反应系统。
从现有的数据库中确定当天和多天住院患者，这些患者在 2014 年 1 月至 2015 年 12 月期间接受了心肺复苏、除颤或两者兼有的尝试复苏定义的 IHCA。
结果测量为：Code Blue 激活次数；Code Blue 激活的潜在可预防性和 IHCA 事件的潜在可预防性。
共有 120 例 IHCA 事件，相当于每 1000 例总入院人数的 0.58 例。由于未能升级、药物错误和不当管理，11 例（9%）IHCA 被认为是潜在可预防的。由于 16 例（62%）病例缺乏生命末期（EOL）护理的识别和记录，以及在已经存在护理限制的情况下 10 例（38%）病例进行不当复苏，因此 39 例（33%）的 120 例 Code Blue 团队激活被认为是潜在可预防的。
研究中心的可预防 IHCA 发生率相对较低，通过改进文档和交接流程，可进一步降低这一比例。通过改善沟通、识别和更早地实施适当的 EOL 护理，将进一步降低这一比例。
