背景:从住院亚急性护理到急性护理的急诊医院间转移发生在8%至17.4%的住院患者中,并与高的急性护理再入院率和住院死亡率相关。亚急性护理中的严重不良事件(快速反应小组或心脏骤停小组呼叫)和增加的护理监测是急诊医院间从亚急性医院转移到急性护理医院的最强已知预测因素。然而,护理各部门临床恶化的流行病学,特别是在亚急性护理中还没有很好的理解。
目的:探讨有或没有从亚急性到急性的院际急诊转院的患者临床恶化的轨迹;并建立一个内部验证的预测模型,以确定生命体征异常在预测这些院际急诊转院中的作用。
方法:这种前瞻性,探索性队列研究是对来自较大病例时间对照研究的数据的亚分析.
方法:维多利亚州五个主要卫生服务机构的八个亚急性护理医院的22个病房,澳大利亚。所有亚急性护理医院在地理上与医疗服务机构的急性护理医院分开。
方法:所有从住院康复或老年评估和管理部门紧急转移到同一卫生服务机构内的急性护理医院的患者。接受姑息治疗的患者被排除在外。
方法:通过病历审核收集了2015年8月22日至2016年10月30日之间的研究数据。Cochran-Mantel-Haenszel检验和双变量逻辑回归分析用于将病例与对照组进行比较,并说明卫生服务聚类效应。
结果:收集了603例转移(557例患者)和1160例对照的数据。针对卫生服务进行了调整,亚急性护理中≥2个生命体征异常(调整后比值比=8.81,95%置信区间:6.36-12.19,p<0.001)和首次急性护理入院期间的严重不良事件(调整后比值比=1.28,95%置信区间:1.08-1.99,p=0.015)是与急诊院间转院风险增加相关的临床因素。内部验证的预测模型表明,生命体征异常可以相当预测从亚急性到急性护理医院的急诊院际转移。
结论:急性护理中的严重不良事件应成为决定亚急性护理分娩位置的关键考虑因素。在亚急性护理期间,15.7%的病例的生命体征符合组织快速反应小组激活标准,然而,错过快速反应团队激活的情况很常见,这表明需要进一步考虑标准和策略,以优化亚急性治疗中临床恶化的识别和反应.
BACKGROUND: Emergency interhospital transfers from inpatient subacute care to acute care occur in 8% to 17.4% of admitted patients and are associated with high rates of acute care readmission and in-hospital mortality. Serious adverse events in subacute care (rapid response team or cardiac arrest team calls) and increased nursing surveillance are the strongest known predictors of emergency interhospital transfer from subacute to acute care hospitals. However, the epidemiology of clinical deterioration across sectors of care, and specifically in subacute care is not well understood.
OBJECTIVE: To explore the trajectory of clinical deterioration in patients who did and did not have an emergency interhospital transfer from subacute to acute care; and develop an internally validated predictive model to identify the role of vital sign abnormalities in predicting these emergency interhospital transfers.
METHODS: This prospective, exploratory cohort study is a subanalysis of data derived from a larger
case-time-control study.
METHODS: Twenty-two wards of eight subacute care hospitals in five major health services in Victoria, Australia. All subacute care hospitals were geographically separate from their health services\' acute care hospitals.
METHODS: All patients with an emergency transfer from inpatient rehabilitation or geriatric evaluation and management unit to an acute care hospital within the same health service were included. Patients receiving palliative care were excluded.
METHODS: Study data were collected between 22 August 2015 and 30 October 2016 by medical record audit. The Cochran-Mantel-Haenszel test and bivariate logistic regression analysis were used to compare cases with controls and to account for health service clustering effect.
RESULTS: Data were collected on 603 transfers (557 patients) and 1160 controls. Adjusted for health service, ≥2 vital sign abnormalities in subacute care (adjusted odds ratio=8.81, 95% confidence intervals:6.36-12.19, p<0.001) and serious adverse events during the first acute care admission (adjusted odds ratio=1.28, 95% confidence intervals:1.08-1.99, p=0.015) were the clinical factors associated with increased risk of emergency interhospital transfer. An internally validated predictive model showed that vital sign abnormalities can fairly predict emergency interhospital transfers from subacute to acute care hospitals.
CONCLUSIONS: Serious adverse events in acute care should be a key consideration in decisions about the location of subacute care delivery. During subacute care, 15.7% of cases had vital signs fulfilling organisational rapid response team activation criteria, yet missed rapid response team activations were common suggesting that further consideration of the criteria and strategies to optimise recognition and response to clinical deterioration in subacute care are needed.