Wireless Clinical Alerts and Patient Outcomes in the Surgical Intensive Care Unit
Wireless Clinical Alerts and Patient Outcomes in the Surgical Intensive Care Unit
复制标题
外科重症监护病房的无线临床警报和患者结果
DOI：
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
S. Cunneen
中科院分区：
文献类型：
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作者：
K. Major;M. Shabot;S. Cunneen
自从医学研究所 1999 年发表有关该主题的报告以来，医学错误引起了公众的兴趣。虽然委托错误经常被提及，但遗漏错误也可能同样严重。计算机化外科重症监护病房 (SICU) 信息系统与事件驱动的警报引擎相结合，有可能减少重症监护病房重大事件的遗漏错误。前瞻性收集所有入住三级护理 SICU 的患者为期 2 年的自动警报和患者结果。研究期间，3,973 名患者入住 SICU，接受了 13,608 天的护理。总共发送了 15,066 个警报页面，包括生理状况警报 (6,163)、实验室数据警报 (4,951)、血气警报 (3,774)、药物过敏警报 (130) 和有毒药物浓度警报 (48)。触发警报系统的患者的入院简化急性生理学评分、急性生理学和慢性健康评估 II 评分、SICU 住院时间和总体死亡率显着较高。与未发出警报的患者相比，触发警报寻呼系统的患者在 SICU 中死亡的可能性高出 49.4 倍。即使在转移到楼层护理后，触发警报系统的患者在医院死亡的可能性也会高出 5.7 倍。警报页面会识别出与不触发警报系统的患者相比，将在 SICU 停留更长时间且死亡几率显着更高的患者。
Errors in medicine have gained public interest since the Institute of Medicine published its 1999 report on this subject. Although errors of commission are frequently cited, errors of omission can be equally serious. A computerized surgical intensive care unit (SICU) information system when coupled to an event-driven alerting engine has the potential to reduce errors of omission for critical intensive care unit events. Automated alerts and patient outcomes were prospectively collected for all patients admitted to a tertiary-care SICU for a 2-year period. During the study period 3,973 patients were admitted to the SICU and received 13,608 days of care. A total of 15,066 alert pages were sent including alerts for physiologic condition (6,163), laboratory data (4,951), blood gas (3,774), drug allergy (130), and toxic drug levels (48). Admission Simplified Acute Physiology Score and Acute Physiology and Chronic Health Evaluation II score, SICU lengths of stay, and overall mortality rates were significantly higher in patients who triggered the alerting system. Patients triggering the alert paging system were 49.4 times more likely to die in the SICU compared with patients who did not generate an alert. Even after transfer to floor care the patients who triggered the alerting system were 5.7 times more likely to die in the hospital. An alert page identifies patients who will stay in the SICU longer and have a significantly higher chance of death compared with patients who do not trigger the alerting system.