Abstract：
OBJECTIVE: Clinical deterioration within the first 24 h of patient admission triggering a Medical Emergency Team (MET) call is a common occurrence. A greater understanding of these events, with a focus on the recognition and management of sepsis, could lead to quality improvement interventions.
METHODS: A retrospective observational review of general and subspecialty medical admissions triggering a MET call within 24 h of admission at a quaternary Australian hospital.
RESULTS: 2648 MET calls occurred (47.9/1000 admissions), 527 (20% of total MET events, 9.5/1000 admissions) within 24 h of admission, with the trigger more likely to be hypotension (odds ratio: 1.5, P = 0.0013). There were 263 MET calls to 217 individual medical patients within 24 h of admission, of which 84 (38.7%) were admitted with suspected infection, 69% of which fulfilled sepsis criteria. Of these, 36.2% received antimicrobial therapy within the recommended timeframe and 39.6% received antibiotics in line with hospital guidelines. Sepsis was initially missed in 11% of patients. Afferent limb failure occurred in 29% of patients with 40.5% experiencing a failure of the ward-based response to deterioration prior to MET call. Median hospital length of stay was increased in patients admitted with suspected infection (7 vs 5 days, P = 0.015) and in those with sepsis not receiving antimicrobial therapy within guideline timeframes (9 vs 4 days, P = 0.017).
CONCLUSIONS: There is a significant opportunity to improve care for patients who trigger a MET within 24 h of admission. This study supports the implementation of a hospital sepsis management guideline.
METHODS: A retrospective observational review of general and subspecialty medical admissions triggering a MET call within 24 h of admission at a quaternary Australian hospital.
RESULTS: 2648 MET calls occurred (47.9/1000 admissions), 527 (20% of total MET events, 9.5/1000 admissions) within 24 h of admission, with the trigger more likely to be hypotension (odds ratio: 1.5, P = 0.0013). There were 263 MET calls to 217 individual medical patients within 24 h of admission, of which 84 (38.7%) were admitted with suspected infection, 69% of which fulfilled sepsis criteria. Of these, 36.2% received antimicrobial therapy within the recommended timeframe and 39.6% received antibiotics in line with hospital guidelines. Sepsis was initially missed in 11% of patients. Afferent limb failure occurred in 29% of patients with 40.5% experiencing a failure of the ward-based response to deterioration prior to MET call. Median hospital length of stay was increased in patients admitted with suspected infection (7 vs 5 days, P = 0.015) and in those with sepsis not receiving antimicrobial therapy within guideline timeframes (9 vs 4 days, P = 0.017).
CONCLUSIONS: There is a significant opportunity to improve care for patients who trigger a MET within 24 h of admission. This study supports the implementation of a hospital sepsis management guideline.
摘要：
目的：患者入院后24小时内引发医疗急救小组（MET）呼叫的临床恶化是常见的情况。对这些事件有更多的了解，专注于败血症的识别和管理，可能导致质量改进干预措施。
方法：对澳大利亚一家第四系医院在入院24小时内触发MET呼叫的一般和亚专科医疗入院的回顾性观察性回顾。
结果：发生了2648次MET呼叫（47.9/1000入院），527（MET事件总数的20％，9.5/1000录取)录取后24小时内，与触发更可能是低血压（比值比：1.5，P=0.0013）。在入院24小时内，有263个MET呼叫217个医疗患者，其中84人(38.7%)因怀疑感染入院，其中69%符合脓毒症标准。其中,36.2%的患者在推荐的时间内接受了抗菌治疗，39.6%的患者接受了符合医院指南的抗生素治疗。最初有11％的患者错过了脓毒症。29％的患者发生传入肢体衰竭，其中40.5％的患者在MET呼叫之前对病区的恶化反应失败。住院的中位住院时间增加了怀疑感染的患者（7vs5天，P=0.015），并且在指导时间范围内未接受抗菌治疗的脓毒症患者（9vs4天，P=0.017)。
结论：对于入院后24小时内触发MET的患者，存在改善护理的重要机会。这项研究支持医院败血症管理指南的实施。
方法：对澳大利亚一家第四系医院在入院24小时内触发MET呼叫的一般和亚专科医疗入院的回顾性观察性回顾。
结果：发生了2648次MET呼叫（47.9/1000入院），527（MET事件总数的20％，9.5/1000录取)录取后24小时内，与触发更可能是低血压（比值比：1.5，P=0.0013）。在入院24小时内，有263个MET呼叫217个医疗患者，其中84人(38.7%)因怀疑感染入院，其中69%符合脓毒症标准。其中,36.2%的患者在推荐的时间内接受了抗菌治疗，39.6%的患者接受了符合医院指南的抗生素治疗。最初有11％的患者错过了脓毒症。29％的患者发生传入肢体衰竭，其中40.5％的患者在MET呼叫之前对病区的恶化反应失败。住院的中位住院时间增加了怀疑感染的患者（7vs5天，P=0.015），并且在指导时间范围内未接受抗菌治疗的脓毒症患者（9vs4天，P=0.017)。
结论：对于入院后24小时内触发MET的患者，存在改善护理的重要机会。这项研究支持医院败血症管理指南的实施。
