Sutherasan Yuda, Theerawit Pongdhep, Suporn Alongkot, Nongnuch Arkom, Phanachet Pariya, Kositchaiwat Chomsri
Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Ther Clin Risk Manag. 2018 Oct 23;14:2089-2095. doi: 10.2147/TCRM.S175092. eCollection 2018.
The aim of this study was to evaluate the impact of a hospital protocol in response to patient deterioration in general wards, stratified using the national early warning score (NEWS), on primary patient outcomes of in-hospital mortality and percentage of patients transferred to the intensive care unit (ICU).
We conducted a prospective observational cohort study among adult medical patients admitted to a university hospital in Bangkok. A 4-month pre-protocol period (November 2015 to February 2016) was assigned to a control group and a protocol period (March 2016 to June 2016) was allocated to a protocol group. On admission, vital signs (respiratory rate, pulse rate, systolic blood pressure, and temperature), oxygen saturation, presence of oxygen supplementation, and neurological status were used to calculate NEWS. Patients were categorized as low, moderate, or high risk based on the NEWS. During protocol period, when patients' conditions are critical and they are at imminent risk, the NEWS detects the event and triggers a systematic response. The response enables closed monitoring and early treatment by expert physicians to rapidly stabilize and triage the patient to a location where services meet the patient's needs. Primary outcomes were compared between the pre-protocol and protocol groups using historical controls for the intervention, which is the availability of NEWS to staff and an associated escalation pathway.
A total of 1,145 patients were included in the analysis: 564 patients in the pre-protocol group and 581 in the protocol group. The mean NEWS of patients at admission was higher in the protocol group than in the pre-protocol group (2.4±2.4 vs 1.77±2.158; <0.001). There was no significant difference for in-hospital mortality and percentage of patients transferred to ICU between the groups. Among 95 (8.3%) patients at moderate risk, in-hospital mortality and ICU transfer percentage were lower in the protocol group than in the pre-protocol group (2.9 vs 15.4%; =0.026; RR 0.188, 95% CI 0.037%-0.968% and 8.7 vs 26.9%; =0.021; RR 0.322, 95% CI 0.12-0.87, respectively).
Implementing the NEWS with the hospital protocol did not change the overall patient's outcomes.
本研究旨在评估一项医院预案在综合病房应对患者病情恶化时的影响，该预案使用国家早期预警评分（NEWS）进行分层，对住院死亡率和转入重症监护病房（ICU）的患者百分比等主要患者结局指标的影响。
我们在曼谷一家大学医院收治的成年内科患者中进行了一项前瞻性观察队列研究。将4个月的预案前时期（2015年11月至2016年2月）分配给对照组，将预案时期（2016年3月至2016年6月）分配给预案组。入院时，使用生命体征（呼吸频率、脉搏率、收缩压和体温）、血氧饱和度、是否吸氧以及神经状态来计算NEWS。根据NEWS将患者分为低、中、高风险类别。在预案时期，当患者病情危急且处于紧迫风险时，NEWS可检测到该事件并触发系统响应。该响应可实现专家医生的密切监测和早期治疗，以便迅速稳定患者病情并将其分诊到能满足患者需求的科室。使用干预措施的历史对照（即工作人员可获取NEWS及相关的升级路径）对预案前组和预案组的主要结局进行比较。
共有1145例患者纳入分析：预案前组564例患者，预案组581例患者。预案组患者入院时的平均NEWS高于预案前组（2.4±2.4对1.77±2.158；<0.001）。两组之间的住院死亡率和转入ICU的患者百分比无显著差异。在95例（8.3%）中度风险患者中，预案组的住院死亡率和ICU转入百分比低于预案前组（分别为2.9%对15.4%；P=0.026；相对危险度0.188，95%可信区间0.037%-0.968%；以及8.7%对26.9%；P=0.021；相对危险度0.322，95%可信区间0.12-0.87）。
实施带有医院预案的NEWS并未改变总体患者结局。
