Centre for Quality and Patient Safety-Eastern Health Partnership, 2/5 Arnold Street, Box Hill, VIC 3128, Australia.
School of Nursing and Midwifery & Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia.
Int J Qual Health Care. 2022 Apr 12;34(2). doi: 10.1093/intqhc/mzac020.
Patient isolation is widely used as a strategy for prevention and control of infection but may have unintended consequences for patients. Early recognition and response to acute deterioration is an essential component of safe, quality patient care and has not been explored for patients in isolation.
The primary aims of this study were to (i) describe the timing, frequency and nature of clinical deterioration during hospital admission for patients with isolation precautions for infection control and (ii) compare the characteristics of patients who did and did not deteriorate during their initial period of isolation precautions for infection control.
This retrospective cohort study was conducted across three sites of a large Australian health service. The study sample were adult patients (≥18 years) admitted into isolation precautions within 24 h of admission from 1 July 2019 to 31 December 2019.
There were 634 patients who fulfilled the study inclusion criteria. One in eight patients experienced at least one episode of clinical deterioration during their time in isolation with most episodes of deterioration occurring within the first 2 days of admission. Timely Medical Emergency Team calls occurred in almost half the episodes of deterioration; however, the same proportion (47.2%) of deterioration episodes resulted in no Medical Emergency Team activation (afferent limb failure). In the 24 h preceding each episode of clinical deterioration (n = 180), 81.6% (n = 147) of episodes were preceded by vital signs fulfilling pre-Medical Emergency Team criteria. Patients who deteriorated during isolation for infection control were older (median age 74.0 vs 71.0 years, P = 0.042); more likely to live in a residential care facility (21.0% vs 7.2%, P = 0.006); had a longer initial period of isolation (4.0 vs 2.9 days, P = < 000.1) and hospital length-of-stay (median 4.9 vs 3.2 days, P = < 0.001) and were more likely to die in hospital (12.3% vs 4.3%, P < 0.001).
Patients in isolation precautions experienced high Medical Emergency Team afferent limb failure and most fulfilled pre-Medical Emergency Team criteria in the 24 h preceding episodes of deterioration. Timely recognition and response to clinical deterioration continue to be essential in providing safe, quality patient care regardless of the hospital-care environment.
患者隔离被广泛用作预防和控制感染的策略，但可能对患者产生意想不到的后果。早期识别和应对急性恶化是安全、高质量患者护理的重要组成部分，但尚未针对接受感染控制隔离措施的患者进行探索。
本研究的主要目的是：(i)描述感染控制隔离患者住院期间临床恶化的时间、频率和性质；(ii)比较在感染控制隔离期间恶化和未恶化的患者的特征。
这是一项在澳大利亚一家大型医疗服务机构的三个地点进行的回顾性队列研究。研究样本为 2019 年 7 月 1 日至 12 月 31 日期间，入院后 24 小时内接受隔离预防措施的成年患者（≥18 岁）。
符合研究纳入标准的患者有 634 名。八分之一的患者在隔离期间至少经历过一次临床恶化，大多数恶化发生在入院后的前 2 天内。几乎一半的恶化事件及时呼叫了医疗急救小组；然而，同样比例（47.2%）的恶化事件没有激活医疗急救小组（传入支失败）。在每次临床恶化发生前的 24 小时内（n=180），81.6%（n=147）的恶化事件之前的生命体征符合医疗急救小组前标准。在感染控制隔离期间恶化的患者年龄更大（中位数 74.0 岁比 71.0 岁，P=0.042）；更有可能居住在养老院（21.0%比 7.2%，P=0.006）；隔离初始时间更长（4.0 天比 2.9 天，P<0.001）和住院时间更长（中位数 4.9 天比 3.2 天，P<0.001），更有可能在医院死亡（12.3%比 4.3%，P<0.001）。
接受隔离预防措施的患者存在高医疗急救小组传入支失败，且在恶化前的 24 小时内大多符合医疗急救小组前标准。无论医院环境如何，及时识别和应对临床恶化对于提供安全、高质量的患者护理仍然至关重要。
