Emergency Services, Illawarra Shoalhaven Local Health District, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Australia.
Emergency Services, Illawarra Shoalhaven Local Health District, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Australia; Susan Wakil School of Nursing and Midwifery, University of Sydney, Australia; George Institute for Global Health, Australia.
Australas Emerg Care. 2023 Dec;26(4):333-340. doi: 10.1016/j.auec.2023.05.001. Epub 2023 May 18.
To determine the impact implementation of Emergency Department Clinical Emergency Response System (EDCERS) on inpatient deterioration events and identify contributing causal factors.
EDCERS was implemented in an Australian regional hospital, integrating a single parameter track and trigger criteria for escalation of care, and emergency, specialty and critical care clinician response to patient deterioration. In this controlled pre-post study, electronic medical records of patients who experienced a deterioration event (rapid response call, cardiac arrest or unplanned intensive care admission) on the ward within 72 h of admission from the emergency department (ED) were reviewed. Causal factors contributing to the deteriorating event were assessed using a validated human factors framework.
Implementation of EDCERS reduced the number of inpatient deterioration events within 72 h of emergency admission with failure or delayed response to ED patient deterioration as a causal factor. There was no change in the overall rate of inpatient deterioration events.
This study supports wider implementation of rapid response systems in the ED to improve management of deteriorating patients. Tailored implementation strategies should be used to achieve successful and sustainable uptake of ED rapid response systems and improve outcomes in deteriorating patients.
确定实施急诊科临床应急响应系统（EDCERS）对住院患者恶化事件的影响，并确定促成恶化的因果因素。
EDCERS 在澳大利亚一家地区医院实施，整合了单一参数跟踪和触发标准，用于升级护理以及急诊、专科和重症监护临床医生对患者恶化的反应。在这项对照前后研究中，回顾了急诊科入院后 72 小时内在病房发生恶化事件（快速反应呼叫、心脏骤停或计划外重症监护入院）的患者的电子病历。使用经过验证的人为因素框架评估导致恶化事件的因果因素。
实施 EDCERS 减少了急诊科入院后 72 小时内的住院患者恶化事件数量，原因是对 ED 患者恶化的反应失败或延迟。住院患者恶化事件的总体发生率没有变化。
本研究支持在急诊科更广泛地实施快速反应系统，以改善对恶化患者的管理。应使用量身定制的实施策略来实现 ED 快速反应系统的成功和可持续采用，并改善恶化患者的结局。
