Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
School of Nursing/Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
J Clin Nurs. 2023 Sep;32(17-18):6450-6459. doi: 10.1111/jocn.16678. Epub 2023 Mar 9.
Although progress has been made in identifying and responding to acutely deteriorating ward patients, judgements about the level of care required for patients after medical emergency team review are complex, rarely including a formal assessment of illness severity. This challenges staff and resource management practices and patient safety.
This study sought to quantify the illness severity of ward patients after medical emergency team review.
This retrospective cohort study examined the clinical records of 1500 randomly sampled adult ward patients following medical emergency team review at a metropolitan tertiary hospital. Outcome measures were the derivation of patient acuity and dependency scores using sequential organ failure assessment and nursing activities score instruments. Findings are reported using the STROBE guideline for cohort studies.
No direct patient contact was made during the data collection and analysis phases of the study.
Patients were male (52.6%), unplanned (73.9%) medical admissions (57.5%), median age of 67 years. The median sequential organ failure assessment score was 4% and 20% of patients demonstrated multiple organ system failure requiring non typical monitoring and coordination arrangements for at least 24 h. The median nursing activities score was 86% suggestive of a near 1:1 nurse-to-patient ratio. More than half of all patients required enhanced levels of assistance with mobilization (58.8%) and hygiene (53.9%) activities.
Patients who remain on the ward following medical emergency team review had complex combinations of organ dysfunction, with levels of dependency similar to those found in intensive care units. This has implications for ward and patient safety and continuity of care arrangements.
Profiling illness severity at the conclusion of the medical emergency team review may help determine the need for special resource and staffing arrangements or placement within the ward environment.
尽管在识别和应对急剧恶化的病房患者方面已经取得了进展，但对于医疗急救团队审查后患者所需护理水平的判断较为复杂，很少包括对疾病严重程度的正式评估。这给医护人员和资源管理实践以及患者安全带来了挑战。
本研究旨在量化医疗急救团队审查后病房患者的疾病严重程度。
这是一项回顾性队列研究，对一家大都市三级医院接受医疗急救团队审查的 1500 名成年病房患者的临床记录进行了检查。使用序贯器官衰竭评估和护理活动评分工具来确定患者的疾病严重程度和依赖程度评分。研究结果使用 STROBE 队列研究指南进行报告。
在数据收集和分析阶段，研究没有直接接触患者。
患者中男性占 52.6%（52.6%），非计划性（73.9%）入院为内科（57.5%），中位年龄为 67 岁。中位序贯器官衰竭评估评分（SOFA）为 4%，20%的患者出现多器官系统衰竭，需要进行非典型监测和协调安排至少 24 小时。中位护理活动评分（Nursing activities score，NAS）为 86%，提示接近 1:1 的护士与患者比例。超过一半的患者需要增强的移动（58.8%）和卫生（53.9%）活动的辅助。
在医疗急救团队审查后留在病房的患者存在复杂的器官功能障碍组合，其依赖程度与重症监护病房相似。这对病房和患者安全以及护理连续性安排有影响。
在医疗急救团队审查结束时对疾病严重程度进行评估，可能有助于确定特殊资源和人员配备安排的需求，或确定患者在病房环境中的安置。
