The Simpson Centre for Health Services Research, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.
BMJ Open Qual. 2022 Aug;11(3). doi: 10.1136/bmjoq-2021-001614.
This study aimed to assess the impact of a standardised rapid response systems (the Between the Flags (BTF)) implemented across New South Wales (NSW), Australia, among female patients.
We conducted an interrupted time series (2007-2013) population-based linkage study including 5 114 170 female patient (≥18 years old) admissions in all 232 public hospitals in NSW. We studied changes in levels and trends of patient outcomes after BTF implementation among four age groups of female patients.
Before the BTF system introduction (2007-2009), for the female patients as a whole, there was a progressive decrease in rates of in-hospital cardiopulmonary arrest (IHCA), IHCA-related mortality and hospital mortality for female patients. However, there were no changes in deaths in low-mortality diagnostic-related groups (DLMDRGs), IHCA survival to discharge and 1-year post-discharge mortality after surviving an IHCA. Only the female patients aged 55 years and older showed the same results as the whole sample. After the BTF programme (2010-2013), the same trends (except for DLMDRG) continued for female patients as a whole and for those aged 55 years or older. There was a significant reduction in DLMDRG among female patients aged 35-54 years (p<0.001), those aged 75 years and over (p<0.05) and female patients as a whole (p<0.05). The decreasing secular trend of surviving an IHCA to hospital discharge before the BTF system (p<0.05) among patients aged 18-34 years old was reversed after the BTF implementation (p<0.01).
For female patients the BTF programme introduction was associated with continued reductions in the rates of IHCA, IHCA-related mortality and hospital mortality, as well as a new reduction in DLMDRG for 35-54 years old patients and those aged 75 years and older, and increased survival for those aged 18-34 years who had suffered an IHCA.
本研究旨在评估在澳大利亚新南威尔士州（NSW）实施的标准化快速反应系统（旗帜之间（BTF））对女性患者的影响。
我们进行了一项基于人群的中断时间序列研究（2007-2013 年），包括 NSW 所有 232 家公立医院的 5114170 名女性患者（≥18 岁）住院。我们研究了 BTF 实施后四个年龄组女性患者的患者结局水平和趋势变化。
在 BTF 系统引入之前（2007-2009 年），对于所有女性患者，院内心肺骤停（IHCA）、IHCA 相关死亡率和女性患者住院死亡率呈逐渐下降趋势。然而，低死亡率诊断相关组（DLMDRG）的死亡率、IHCA 存活出院和 1 年后出院后死亡率没有变化。只有 55 岁及以上的女性患者表现出与全样本相同的结果。在 BTF 计划（2010-2013 年）之后，全样本和 55 岁及以上女性患者的相同趋势（除了 DLMDRG）仍在继续。35-54 岁女性患者（p<0.001）、75 岁及以上女性患者（p<0.05）和全样本女性患者（p<0.05）的 DLMDRG 显著减少。BTF 系统引入前，18-34 岁患者 IHCA 存活出院的下降趋势（p<0.05）在 BTF 实施后发生逆转（p<0.01）。
对于女性患者，BTF 计划的引入与 IHCA、IHCA 相关死亡率和住院死亡率的持续下降有关，以及 35-54 岁和 75 岁及以上患者 DLMDRG 的新下降，以及 IHCA 后存活的 18-34 岁患者的生存率提高。
