일개 종합병원의 조기대응팀의 활동에 사용되는 스크리닝 시스템의 유용성
Usefulness of Screening Criteria System Used by Medical Alert Team in a General Hospital
1
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Background: Rapid response team (RRT) is becoming an essential part of patient safety by the early recognition and management of patients on general hospital wards. In this study, we analyzed the usefulness of screening criteria of RRT used at Asan Medical Center. Methods: On a retrospective basis, we reviewed the records of 675 cases in 543 patients that were managed by RRT (called medical alert team in the Asan Medical Center), from July 2011 to December 2011. The medical alert team was acted by requests of attending doctors or nurses or the medical alert system (MAS) criteria composed of abnormal vital sign, neurology, laboratory data and increasing oxygen demand. We investigated the patterns of MAS criteria for targeting the patients who were managed by the medical alert team. Results: Respiratory distress (RR ＞ 25/min) was the most common item for identifying patients whose condition had worsened. The criteria consist with respiratory distress and abnormal blood pressure (mean BP ＜ 60 mmHg or systolic BP ＜ 90 mmHg) found 70.0% of patients with deteriorated conditions. Vital sign (RR ＞ 25/min, mean BP ＜ 60 mmHg or systolic BP ＜ 90 mmHg, pulse rate, PR ＞ 130/min or ＜ 50/min) and oxygen demand found 79.2% of them. Vital signs, arterial blood gas analysis (ABGA) with lactate level (pH, pO2, pCO2, and lactate) and O2 demand found 98.6% of patient conditions had worsened. Conclusions: Vital signs, especially RR ＞ 25/min is useful criteria for detecting patients whose conditions have deteriorated. The addition of ABGA data with lactate levels leads to a more powerful screening tool.
Abstract
Background: Rapid response team (RRT) is becoming an essential part of patient safety by the early recognition and management of patients on general hospital wards. In this study, we analyzed the usefulness of screening criteria of RRT used at Asan Medical Center. Methods: On a retrospective basis, we reviewed the records of 675 cases in 543 patients that were managed by RRT (called medical alert team in the Asan Medical Center), from July 2011 to December 2011. The medical alert team was acted by requests of attending doctors or nurses or the medical alert system (MAS) criteria composed of abnormal vital sign, neurology, laboratory data and increasing oxygen demand. We investigated the patterns of MAS criteria for targeting the patients who were managed by the medical alert team. Results: Respiratory distress (RR ＞ 25/min) was the most common item for identifying patients whose condition had worsened. The criteria consist with respiratory distress and abnormal blood pressure (mean BP ＜ 60 mmHg or systolic BP ＜ 90 mmHg) found 70.0% of patients with deteriorated conditions. Vital sign (RR ＞ 25/min, mean BP ＜ 60 mmHg or systolic BP ＜ 90 mmHg, pulse rate, PR ＞ 130/min or ＜ 50/min) and oxygen demand found 79.2% of them. Vital signs, arterial blood gas analysis (ABGA) with lactate level (pH, pO2, pCO2, and lactate) and O2 demand found 98.6% of patient conditions had worsened. Conclusions: Vital signs, especially RR ＞ 25/min is useful criteria for detecting patients whose conditions have deteriorated. The addition of ABGA data with lactate levels leads to a more powerful screening tool.
참고문헌 (15)
- Wilson RM, "An analysis of the causes of adverse events from the Quality in Australian Health Care Study", Med J Aust, 170, pp.411~415 (1999)
- Brennan TA, "Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I", N Engl J Med, 324, pp.370~376 (1991)
- Leape LL, "The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II", N Engl J Med, 324, pp.377~384 (1991)
- Schein RM, "Clinical antecedents to in-hospital cardiopulmonary arrest", Chest, 98, pp.1388~1392 (1990)
- Buist MD, "Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study", BMJ, 324, pp.387~390 (2002)
- Bellomo R, "A prospective before-and-after trial of a medical emergency team", Med J Aust, 179, pp.283~287 (2003)
- Berwick DM, "The 100,000 lives campaign: setting a goal and a deadline for improving health care quality", JAMA, 295, pp.324~327 (2006)
- 박태진, "내과계 중환자실 입실 시간에 따른 급성 중증 환자의 예후", 대한중환자의학회지, 25(2), pp.71~75 (2010), 대한중환자의학회
- Chan PS, "Rapid Response Teams: A systematic review and meta-analysis", Arch Intern Med, 170, pp.18~26 (2010)
- Cioffi J, "Nurses' experiences of making decisions to call emergency assistance to their patients", J Adv Nurs, 32, pp.108~114 (2000)
- Franklin C, "Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event", Crit Care Med, 22, pp.244~247 (1994)
- Goldhill DR, "The patient-at-risk team: identifying and managing seriously ill ward patients", Anaesthesia, 54, pp.853~860 (1999)
- Goldhill DR, "Physiological values and procedures in the 24 h before ICU admission from the ward", Anaesthesia, 54, pp.529~534 (1999)
- Harrison GA, "The prevalence of recordings of the signs of critical conditions and emergency responses in hospital wards--the SOCCER study", Resuscitation, 65, pp.149~157 (2005)
- Cretikos M, "MERIT study investigators: The objective medical emergency team activation criteria: a case-control study", Resuscitation, 73, pp.62~72 (2007)