MEDICAL EARLY RESPONSE INTERVENTION AND THERAPY (MERIT): A RANDOMISED CLINICAL TRIAL

医疗早期反应干预和治疗（优点）：随机临床试验

• 批准号: nhmrc : 209578
• 负责人: A/Pr Gordon Doig
• 金额: $ 35.37万
• 依托单位国家: 澳大利亚
• 项目类别: NHMRC Project Grants
• 财政年份: 2002
• 资助国家: 澳大利亚
• 起止时间: 2002-01-01 至 2004-12-31
• 项目状态: 已结题
• 来源: https://researchdata.edu.au/medical-early-response-clinical-trial/98417
• 关键词: MEDICAL; EARLY; RESPONSE; INTERVENTION; THERAPY

Every year, between 12,000 and 23,000 deaths are associated with in-hospital adverse events, making them one of the leading causes of death in the general population. These adverse events lost Australia over three million bed-days per year, and cost the country up to $4.7 billion every year. Among the adverse events, death, cardiac arrest and unplanned admissions to intensive care unit (ICU) are the most serious occurrences. The majority of the events were preceded by serious clinical deterioration, which can be easily identified. Recognising these problems, a hospital-wide intervention system called the Medical Emergency Team (MET) has been developed in Australia over the last 10 years. Under this system, when a patient's clinical condition is unstable, a call is immediately placed to the MET for intervention. Preliminary data have shown that the MET can reduce in-hospital deaths, cardiac arrests and unplanned ICU admissions. However, past studies have been based on observational design and their results lack scientific credence due to uncontrolled confounders and biases. It is proposed to conduct a multi-centre randomised clinical trial to test the hypothesis that the implementation of the hospital-wide MET system will reduce the aggregate incidence of the following three adverse events: unplanned admissions to intensive care units, cardiopulmonary arrest, and in-hospital death. The study will involve 20 Australian and New Zealand hospitals, each with at least 20,000 admissions per year. This study will provide crucial scientific evidence for health managers and governments to make decision on the implementation of MET in Australian and New Zealand hospitals. If the MET system is shown to reduce adverse events as observed in preliminary studies, then the introduction of MET could save approximately 4000 lives, avoid 1500 cardiac arrests, and prevent 2500 unplanned ICU admissions every year.

每年有12，000至23，000例死亡与院内不良事件有关，使其成为一般人群死亡的主要原因之一。这些不良事件使澳大利亚每年损失超过300万个卧床日，每年花费高达47亿美元。在不良事件中，死亡、心脏骤停和计划外入住重症监护室（ICU）是最严重的事件。大多数事件发生前出现严重临床恶化，这很容易识别。认识到这些问题，澳大利亚在过去10年中建立了一个称为医疗急救队的医院范围的干预系统。在这一制度下，当病人的临床状况不稳定时，会立即打电话给MET进行干预。初步数据显示，MET可以减少院内死亡、心脏骤停和计划外ICU入院。然而，过去的研究一直基于观察设计，由于不受控制的混杂因素和偏倚，其结果缺乏科学可信度。建议进行一项多中心随机临床试验，以检验以下假设：实施全院MET系统将降低以下三种不良事件的总发生率：计划外入住重症监护室、心肺骤停和院内死亡。该研究将涉及20家澳大利亚和新西兰医院，每家医院每年至少有20，000名住院患者。这项研究将为澳大利亚和新西兰的卫生管理者和政府制定实施MET的决策提供重要的科学依据。如果MET系统被证明可以减少初步研究中观察到的不良事件，那么MET的引入每年可以挽救大约4000人的生命，避免1500次心脏骤停，并防止2500次计划外ICU入院。