Department of Critical Care Medicine, St Vincent's Hospital (Melbourne), Fitzroy, VIC, Australia.
Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, SA, Australia.
Crit Care Med. 2018 Jul;46(7):1063-1069. doi: 10.1097/CCM.0000000000003126.
Medical emergency teams were established to rescue patients experiencing clinical deterioration thus preventing cardiac arrest and unexpected hospital mortality. Although hospitals are encouraged to increase emergency calling rates to improve in-hospital mortality, there are increasing concerns about the impact these calls have on the workload of the teams and the skill levels on the general wards. We set out to examine the relationship between emergency calling rates and adjusted in-hospital mortality.
Retrospective analysis of prospectively collected patient and emergency call data.
Tertiary, metropolitan, and regional hospitals in the State of Victoria, Australia.
Consecutive patients discharged from 1) St Vincent's Hospital Melbourne from January 2008 to June 2016 and 2) 15 Victorian hospitals from July 2010 to June 2015.
We studied 441,029 patients from St Vincent's Hospital Melbourne. Median age was 61.0 years (interquartile range, 45-74 yr), 57.2% were men, and 0.70% died; monthly emergency calling rates varied between 9.21 and 30.69 (median 18.4) per 1,000 discharges. In-hospital mortality adjusted for age, gender, emergency status, same day admission, year of discharge, and Charlson Comorbidity Index was not reduced by higher calling rates in the month of discharge (odds ratio, 1.019; 95% CI, 1.008-1.031). We then examined 3,339,789 discharges from 15 Victorian hospitals with median age 61 years (interquartile range, 43-74 yr), 51.4% men, and hospital mortality 0.83% where yearly emergency calling rates varied from 18.46 to 33.40 (median, 25.75) per 1,000 discharges. Again, adjusted mortality was not reduced by higher calling rates in the year of discharge (odds ratio, 1.003; 95% CI, 1.001-1.006).
With adjustment for patient factors, illness, and comorbidities, increased emergency calling rates were not associated with reduced in-hospital mortality. Efforts to increase calling rates do not seem warranted.
设立医疗急救团队是为了抢救出现临床恶化的患者，从而预防心脏骤停和医院内意外死亡。尽管医院被鼓励提高急救呼叫率以提高院内死亡率，但人们越来越担心这些呼叫对团队的工作量和普通病房的技能水平的影响。我们着手研究急救呼叫率与调整后的院内死亡率之间的关系。
前瞻性收集患者和急救呼叫数据的回顾性分析。
澳大利亚维多利亚州的三级、都会和区域医院。
2008 年 1 月至 2016 年 6 月期间从墨尔本圣文森特医院出院的连续患者和 2010 年 7 月至 2015 年 6 月期间从维多利亚州的 15 家医院出院的连续患者。
我们研究了墨尔本圣文森特医院的 441,029 名患者。中位年龄为 61.0 岁（四分位距，45-74 岁），57.2%为男性，0.70%死亡；每月急救呼叫率在 9.21 至 30.69（中位数 18.4）之间变化/每 1000 出院人次。在调整了年龄、性别、急救状态、同日入院、出院年份和 Charlson 合并症指数后，出院当月的高呼叫率并没有降低院内死亡率（比值比，1.019；95%置信区间，1.008-1.031）。然后，我们检查了 15 家维多利亚州医院的 3,339,789 名出院患者，中位年龄为 61 岁（四分位距，43-74 岁），51.4%为男性，医院死亡率为 0.83%，每年的急救呼叫率在 18.46 至 33.40（中位数，25.75）/每 1000 出院人次之间变化。同样，在出院年份，调整后的死亡率并没有因较高的呼叫率而降低（比值比，1.003；95%置信区间，1.001-1.006）。
在调整了患者因素、疾病和合并症后，急救呼叫率的增加与院内死亡率的降低无关。增加呼叫率的努力似乎没有必要。
