Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team
Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team
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DOI：
10.5694/j.1326-5377.2000.tb125627.x
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发表时间：
2000-09-04
影响因子：
11.4
通讯作者：
Simmons, EG
中科院分区：
文献类型：
--
作者：
Bristow, PJ;Hillman, KM;Simmons, EG
目的：评估医疗急救小组 (MET) 在降低选定不良事件发生率方面的有效性。设计：病例组合调整后的队列比较研究。患者和环境：1996 年 7 月 8 日至 12 月 31 日期间入住三所澳大利亚公立医院的所有成年（大于或等于 14 岁）患者。干预研究：在 1 号医院，如果生理参数异常或工作人员担心，可能会召集医疗急救小组 (MET)。 2 号和 3 号医院有传统的心脏骤停团队。主要结局指标：根据病例组合调整的心脏骤停率、意外入住重症监护病房 (ICU)、死亡以及没有预先存在的“不复苏”(DNR) 命令记录的死亡亚组。结果：在 50 942 例住院患者中发现了 1510 起不良事件。总体而言，干预医院的意外 ICU 入院率较低（病例组合调整优势比：医院 1，1.00；医院 2，1.59 [95% CI，1.24-2.04] 医院 3，1.73 [95% CI，1.37-2.16]）。三家医院之间心脏骤停或总死亡的发生率没有显着差异。然而，其中一家拥有传统心脏骤停团队的医院在没有 DNR 指令的患者中死亡率较高。结论：MET 医院意外 ICU/HDU 入院人数较少，院内骤停率或总死亡率没有增加。与其他医院之一相比，非 DNR 死亡人数为 Tower；然而，我们没有针对 DNR 做法进行调整。我们认为MET概念值得进一步研究。
Objectives: To evaluate the effectiveness of a medical emergency team (MET) in reducing the rates of selected adverse events.Design: Cohort comparison study after casemix adjustment.Patients and setting: All adult (greater than or equal to 14 years) patients admitted to three Australian public hospitals from 8 July to 31 December 1996.Intervention studied: At Hospital 1, a medical emergency team (MET) could be called for abnormal physiological parameters or staff concern. Hospitals 2 and 3 had conventional cardiac arrest teams.Main outcome measures: Casemix-adjusted rates of cardiac arrest, unanticipated admission to intensive care unit (ICU), death, and the subgroup of deaths where there was no pre-existing "do not resuscitate" (DNR) order documented.Results: There were 1510 adverse events identified among 50 942 admissions. The rate of unanticipated ICU admissions was less at the intervention hospital in total (casemix-adjusted odds ratios: Hospital 1, 1.00; Hospital 2, 1.59 [95% CI, 1.24-2.04] Hospital 3, 1.73 [95% CI, 1.37-2.16]). There was no significant difference rn the Fates of cardiac arrest or total deaths between the three hospitals. However, one of the hospitals with a conventional cardiac arrest team had a higher death rate among patients without a DNR order.Conclusions: The MET hospital had fewer unanticipated ICU/HDU admissions, with no increase in in-hospital arrest rate or total death rate. The non-DNR deaths were Tower compared with one of the other hospitals; however, we did not adjust for DNR practices. We suggest that the MET concept is worthy of further study.