Ramirez-Cueva Fatima, Prusky Grinberg Gary, Kuchinski Ann Marie, Gibson Robert, Xu Hongyan, Zhang Li Fang, Seeyave Desiree
From the Department of Emergency Medicine, Medical College of Georgia at Augusta University, Augusta, Ga.
Pediatr Qual Saf. 2023 Aug 7;8(4):e678. doi: 10.1097/pq9.0000000000000678. eCollection 2023 Jul-Aug.
Direct admissions (DAs) are a routine hospital entry portal with few guidelines to assess patient safety during this process. This study assessed the effectiveness of an institutional screen for patients presenting as DA. It investigated patient variables that may predict appropriateness for DA and those at high risk for deterioration.
The study includes patients who received the institutional screen between June 1, 2019, and May 31, 2020. We placed charts into three groups: group 1 (stable), group 2 (unstable), and group 3 (stable then transferred to pediatric intensive care unit within 6 hours). We assessed effectiveness by calculating sensitivity, specificity, and predictive values. We used comparative analysis between groups to identify patients safe for DA and those at high risk for deterioration.
The screen was 80% sensitive and 100% specific, predicting 97.7% of stable patients. Of the 652 charts reviewed, 384 met the inclusion criteria. Group 1 (31.60, 26.45%, 5.23%) had lower respiratory rate, respiratory diagnosis, and oxygen requirement compared to group 2 (45.00, 78.13%, 15.63%) and group 3 (44.50, 75.00%, 50.00%). For SpO, group 1 (98.70) was higher than group 2 (96.03). For the Pediatric Early Warning Score, group 2 (1.72) was higher than group 1 (0.31) and group 3 (0.63).
The institutional screen is an effective tool to identify patients presenting as DA needing immediate emergency department intervention and/or pediatric intensive care unit care. The screen benefits patients with a respiratory diagnosis, oxygen requirement, high respiratory rate or low SpO.
直接入院（DAs）是医院常规的入院途径，在此过程中评估患者安全的指南很少。本研究评估了针对直接入院患者的机构筛查的有效性。它调查了可能预测直接入院适宜性的患者变量以及那些恶化风险高的变量。
该研究纳入了2019年6月1日至2020年5月31日期间接受机构筛查的患者。我们将病历分为三组：第1组（稳定）、第2组（不稳定）和第3组（稳定但在6小时内转入儿科重症监护病房）。我们通过计算敏感性、特异性和预测值来评估有效性。我们使用组间比较分析来确定适合直接入院的患者和恶化风险高的患者。
该筛查的敏感性为80%，特异性为100%，预测了97.7%的稳定患者。在审查的652份病历中，384份符合纳入标准。与第2组（45.00，78.13%，15.63%）和第3组（44.50，75.00%，50.00%）相比，第1组（31.60，26.45%，5.23%）的呼吸频率、呼吸诊断和氧气需求较低。对于血氧饱和度（SpO），第1组（98.70）高于第2组（96.03）。对于儿科早期预警评分，第2组（1.72）高于第1组（0.31）和第3组（0.63）。
机构筛查是识别那些作为直接入院患者需要立即进行急诊科干预和/或儿科重症监护病房护理的有效工具。该筛查对有呼吸诊断、氧气需求、高呼吸频率或低血氧饱和度的患者有益。
