快速反应系统的引入降低美国退伍军人医院心搏骤停事件

背景本研究拟探讨快速反应系统对美国退伍军人人群的心搏骤停率和死亡率的影响。方法我们对快速反应系统建立前9个月及建立后27个月内发生的心搏骤停进行前瞻性分析，并对干预前3．5年及干预后27个月后的死亡率进行回顾性分析。研究对象包括快速反应系统建立前及建立后的大学所属美国退伍军人医学中心的所有住院患者，该系统包括培训方案、患者呼。1标准及由内科医生领导的急救医疗小组。研究的主要终，点为与标准化出院相关的医院覆盖区域内心搏骤停及死亡率。采用方差分析比较该系统实施中不同时间点的心搏骤停率和死亡率。结果研究期间急救医疗小组共收到378次呼n1．．与干预前相比，心搏骤停下降了57％，达到每1000例出院患者心搏骤停数为5．6（P〈0．01）。干预中死亡率的降低则归因于研究各阶段发生率的自然下降。结论此项干预可以显著降低心搏骤停率，同时死亡率也呈下降趋势。我们估计研究期间共防止了51例心搏骤停。结果表明在退伍军人医疗网络中推广快速反应系统可进一步降低死亡率。

BACKGROUND： We sought to determine the impact of a rapid response system on cardiac arrest rates and mortality in a United States veteran population. METHODS： We describe a prospective analysis of cardiac arrests in 9 months before and 27 months after institution of a rapid response system, and retrospective analysis of mortality 3.5 years before the intervention and 27 months after the intervention. The study included all inpatients from a university-affiliated United States Veterans Affairs Medical Center, before and after implementation of a rapid response system, including an educational program, patient calling criteria, and a physician-led medical emergency team. Primary end points were hospital- wide cardiac arrests and mortality rates normalized to hospital discharges. Comparisons of event rates between various time points during the implementation process were made by analysis of variance. RESULTS： Three hundred seventy-eight calls were made to the medical emergency team in the time period studied. Compared with preintervention time points, cardiac arrests were reduced by 57%, amounting to a reduction of 5. 6 cardiac arrests per 1000 hospital discharges （P 〈 0. 01 ）. Mortality was reduced during the intervention, but this was attributable to a natural decrease occurring over all phases of the study. CONCLUSIONS： A significant reduction in the rate of cardiac arrests was realized with this intervention, as well as a trend toward lower mortality. We estimate that 51 arrests were prevented in the timeffame studied. Our results suggest that further reductions in morbidity can be realized by expansion of rapid response systems throughout the Veterans Affairs network.