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

每年有12,000至23,000例死亡与住院期间的不良事件有关，使其成为普通人群的主要死亡原因之一。这些不良事件每年使澳大利亚损失300多万个卧床日，每年给国家造成的损失高达47亿美元。在不良事件中，死亡、心脏骤停和意外进入重症监护病房(ICU)是最严重的事件。大多数事件之前都有严重的临床恶化，这是很容易识别的。认识到这些问题，澳大利亚在过去10年里开发了一种名为医疗急救小组(MET)的医院范围的干预系统。在这个系统下，当患者的临床情况不稳定时，会立即打电话给MET进行干预。初步数据显示，MET可以减少住院死亡、心脏骤停和非计划的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差，他们的结果缺乏科学可信度。建议进行一项多中心随机临床试验，以检验这样一种假设，即在医院范围内实施MET系统将减少以下三种不良事件的总发生率：意外入院重症监护病房、心肺骤停和住院死亡。这项研究将涉及澳大利亚和新西兰的20家医院，每家医院每年至少有2万名患者入院。这项研究将为卫生管理者和政府决定在澳大利亚和新西兰的医院实施MET提供重要的科学依据。如果初步研究表明MET系统可以减少不良事件，那么MET的引入可以挽救大约4000人的生命，避免1500例心脏骤停，并防止每年2500例计划外ICU入院。

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.