Westacott Lorraine, Graves Judy, Khatun Mohsina, Burke John
Metro South Addictions and Mental Health Services, Building 23, Garden City Office Park, 2404 Logan Rd, Eight Mile Plains, Qld 4113, Australia.
Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Qld 4029, Australia. Email:.
Aust Health Rev. 2018 Sep;42(5):607-613. doi: 10.1071/AH17089.
Objectives Any new model of care should always be accompanied by rigorous monitoring to ensure that there are no negative consequences, especially any that impact upon patient safety. In 2013, 'THERMoSTAT' (Two- Hour Evaluation and Referral Model for Shorter Turnaround Times), an emergency department model of care developed by Royal Brisbane and Women's Hospital staff was launched to gain efficiencies and improve hospital National Emergency Access Target (NEAT) compliance. The aim of this study was to trial the use of medical emergency call data as a novel marker of the quality of care delivered by our emergency department. Methods Incidence of medical emergency calls for hospital emergency admission patients for the 2 years pre- and 1 year post-THERMoSTAT were compared after standardising for overall hospital activity. Results During the study period, hospital activity increased 10%, and the emergency department experienced a total of 222645 presentations, 68000 (30.5%) of which converted into an admission. THERMoSTAT improved NEAT compliance by 17% (from 57.7% to 74.9%) with no change in any patient-safety indicators. A total of 8432 medical emergency calls were made on 5930 patients, 2831 of whom were emergency admissions. After adjusting for hospital activity, there was no change in the average number of patients per week who triggered a medical emergency call after the introduction of THERMoSTAT. These results were reproduced when data was analysed for: total number of inpatients triggering calls; emergency admission patients; and emergency admission patients within the first 24h or first 4h of admission. Conclusions This is the first report to investigate the correlation between inpatient medical emergency call incidence and emergency department model of care. Medical emergency call data showed significant promise as a measure of morbidity and as a more direct, objective, simple, quantitative and meaningful measure of patient safety. What is known about the topic? It is well established that extended emergency department lengths of stay are associated with poorer patient outcomes. The corollary of this is not always true however; shorter emergency department length of stay does not automatically translate into better care. Although the underlying philosophy of NEAT is to enhance patient care, there is a risk of negative consequences if NEAT is seen as an end in itself. Many of the commonly used emergency department key performance indicators focus on the timeliness of care and there is a scarcity of easily quantifiable markers that reliably reflect the quality of that care. What does this paper add? This study builds on the concept of medical emergency call incidence as a marker of safety and quality. It explores the utility of using the number of medical emergency calls made in the first few hours of an emergency admission as an indicator of the quality of care delivered by the emergency department. This is significant because it introduces a measure that has a focus that embraces more than the timeliness of care only. What are the implications for practitioners? If medical emergency call incidence in early emergency admissions can be proven to accurately reflect emergency department quality of care then it would provide an easily monitored, objective, quantitative and prompt measure that evaluates dimensions other than timeliness.
目标 任何新的护理模式都应始终伴随严格的监测，以确保不会产生负面后果，尤其是任何影响患者安全的后果。2013年，由皇家布里斯班妇女医院工作人员开发的急诊科护理模式“THERMoSTAT”（缩短周转时间的两小时评估和转诊模式）启动，旨在提高效率并改善医院对国家紧急就诊目标（NEAT）的依从性。本研究的目的是试验将医疗紧急呼叫数据用作我们急诊科提供护理质量的一种新指标。方法 在对全院总体活动进行标准化后，比较了THERMoSTAT实施前2年和实施后1年医院急诊入院患者的医疗紧急呼叫发生率。结果 在研究期间，医院活动增加了10%，急诊科共接待了222645名患者，其中68000名（30.5%）转为住院。THERMoSTAT使NEAT依从性提高了17%（从57.7%提高到74.9%），且任何患者安全指标均无变化。共对5930名患者拨打了8432次医疗紧急呼叫，其中2831名是急诊入院患者。在调整医院活动后，引入THERMoSTAT后每周触发医疗紧急呼叫的患者平均数量没有变化。当对以下数据进行分析时，这些结果得到了重现：触发呼叫的住院患者总数；急诊入院患者；以及入院后最初24小时或最初4小时内的急诊入院患者。结论 这是第一份调查住院患者医疗紧急呼叫发生率与急诊科护理模式之间相关性的报告。医疗紧急呼叫数据作为发病率的一种衡量指标以及作为一种更直接、客观、简单、定量且有意义的患者安全衡量指标显示出巨大潜力。关于该主题已知的情况是什么？ 急诊部住院时间延长与较差的患者结局相关，这一点已得到充分证实。然而，其推论并非总是正确的；急诊部住院时间缩短并不一定会转化为更好的护理。尽管NEAT的基本理念是加强患者护理，但如果将NEAT视为目的本身，则存在产生负面后果的风险。许多常用的急诊科关键绩效指标侧重于护理的及时性，而缺乏能够可靠反映该护理质量的易于量化的指标。本文补充了什么？ 本研究基于将医疗紧急呼叫发生率作为安全和质量指标的概念。它探讨了将急诊入院最初几小时内拨打的医疗紧急呼叫数量用作急诊科提供护理质量指标的效用。这很重要，因为它引入了一种不仅关注护理及时性的衡量指标。对从业者有何影响？ 如果能够证明急诊早期入院时的医疗紧急呼叫发生率准确反映了急诊科的护理质量，那么它将提供一种易于监测、客观、定量且及时的衡量指标，可评估除及时性之外的其他维度。
