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首页> 外文期刊>The Internet Journal of Emergency and Intensive Care Medicine >The Effectiveness of ICU Triage for Inpatient Medical Services in an Urban Teaching Hospital
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The Effectiveness of ICU Triage for Inpatient Medical Services in an Urban Teaching Hospital

机译：ICU分诊在城市教学医院住院医疗服务中的有效性

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Identifying when hospitalized patients become critically ill and appropriately triaging them is essential to providing optimal outcomes for these patients. Arguably the worst potential outcome is a life-threatening or terminal event, which initiates a ‘code blue’ response. We assessed the effectiveness of intensive care unit (ICU) triage for inpatient medical services in an urban academic hospital using ‘code blue’ events as a measure of triage effectiveness. All codes that occurred for the period of 1/1/2004 until 12/31/2005 on inpatient medical services were identified. Charts were reviewed to see whether or not a medical ICU or coronary ICU consultation note was on the chart within the 48 hours prior to the code event to evaluate the patient for transfer to the ICU. Triage error leading to a ‘code blue’ event in the 48 hours following the ICU consult was rare, occurring at a rate of 1 per 1,000 consultations. Introduction It has been estimated that failure to rescue follows 17% of major complications (e.g., pneumonia, sepsis, thromboembolic events, acute renal failure, GI hemorrhage and cardiac arrest) in US hospitals [1]. This translates to approximately 268,000 cases per year. Thus, the identification of critically ill inpatients and triage to an appropriate level of care is essential to provide optimal outcomes. This concept is central to the national movement towards the development of “rapid response teams,” [2] the creation of which has been met with some controversy [3]. Our goal was to evaluate the effectiveness of inpatient intensive care unit (ICU) triage as part of a needs assessment for creating a rapid response team at our institution. Materials and Methodology The study was performed at the Virginia Commonwealth University Medical Center, an 820-bed, urban teaching hospital with approximately 33,000 admissions yearly. During the study period our institution did not have a rapid response or medical emergency team. At that time, when a patient’s condition worsened and the patient was deemed to possibly require ICU level care, the resident on call for the respective ICU was consulted, evaluated the patient, and then reviewed the case with a critical care or cardiology fellow. A decision regarding transfer was then made and a consultation note was placed in the medical record. To examine the effectiveness of this ICU triage system, we evaluated ‘code blue’ events that occurred over a two-year period between 1/1/2004 and 12/31/2005 in adult patients on medical services. This was accomplished via review of our institution’s data in the National Registry of CardioPulmonary Resuscitation (NRCPR), a nationwide registry of inpatient resuscitation events sponsored by the American Heart Association. The medical records of these patients were then reviewed to determine whether a critical care consultation had occurred in the 48 hour period prior to their event. Data for these patients were abstracted to calculate SAPS II [4] and Charlson scores. The SAPS II score is a severity of acute illness indicator derived from 17 variables that provides an estimate of mortality. It involves a 163-point scale, with higher scores associated with higher mortality [4, 5]. The Charlson score involves a 43-point scale that provides prognostic information based on comorbid conditions, with higher scores being associated with a higher risk of death secondary to a comorbid cause [6]. Data on code types and ultimate outcomes were collected, as well. Information on the total number of consults for medical ICUs for the period of interest was not available; however, we were able to obtain data on the total number of admissions to the ICUs. In order to estimate the number of consults performed, we surveyed cardiology and critical care fellows (3 of each from multiple different years of training) as to the typical number of consults and admissions that occur per day, asking them to take into account any seasonal variations that may occur. These res
机译：识别住院患者何时患上重病并对其进行适当分流对于为这些患者提供最佳结果至关重要。可以说，最糟糕的潜在后果是威胁生命或终止生命的事件，这会引发“蓝色代码”响应。我们使用“蓝色代码”事件作为分流有效性的衡量指标，评估了重症监护病房（ICU）分流在城市学术医院中住院医疗服务的有效性。确定了2004年1月1日至2005年12月31日期间发生的所有住院医疗服务代码。检查图表以查看代码事件发生前48小时内图表上是否有医疗ICU或冠状动脉ICU咨询记录，以评估患者是否需要转入ICU。在ICU咨询后的48小时内导致“代码蓝”事件的分类错误很少见，发生率为每千个咨询1例。引言据估计，在美国医院中，挽救失败的发生率是主要并发症（例如肺炎，败血症，血栓栓塞事件，急性肾衰竭，胃肠道出血和心脏骤停）的17％[1]。这意味着每年大约有268,000个案例。因此，对危重住院病人的识别和分流到适当的护理水平对于提供最佳结果至关重要。这一概念对于全国发展“快速反应小组”的运动至关重要[2]，其建立也引起了一些争议[3]。我们的目标是评估住院重症监护病房（ICU）分诊的有效性，这是在我们机构中建立快速反应团队的需求评估的一部分。材料和方法这项研究是在弗吉尼亚联邦大学医学中心进行的，该中心有820张床，是城市教学医院，每年约有33,000名患者入院。在研究期间，我们的机构没有快速反应或医疗急救小组。当时，当患者的病情恶化并且认为患者可能需要ICU级护理时，应征求住院医师就诊的相应ICU的咨询意见，对患者进行评估，然后与重症监护或心脏病专家一起对该病例进行检查。然后做出有关转移的决定，并在病历中放入一份咨询记录。为了检查这种ICU分诊系统的有效性，我们评估了2004年1月1日至2005年12月31日这两年间成年患者在医疗服务中发生的“代码蓝”事件。这是通过对美国心肺复苏国家注册中心（NRCPR）中我们机构数据的审查来完成的，NRCPR是由美国心脏协会发起的全国性住院复苏事件注册中心。然后检查这些患者的病历，以确定在事件发生前的48小时内是否进行了重症监护咨询。将这些患者的数据提取出来以计算SAPS II [4]和Charlson评分。 SAPS II得分是急性疾病指标的严重性，该指标来自17个变量，可估计死亡率。它涉及163点量表，分数越高，死亡率越高[4，5]。 Charlson评分涉及43分制，可根据合并症提供预后信息，较高的评分与合并症继发的更高死亡风险相关[6]。还收集了有关代码类型和最终结果的数据。尚无有关感兴趣期间医疗ICU咨询总数的信息;但是，我们能够获得有关ICU入学总数的数据。为了估计进行咨询的人数，我们调查了心脏病学和重症医学研究人员（来自不同培训年限的每人中有3名）每天发生的典型咨询和住院人数，要求他们考虑任何季节性因素可能发生的变化。这些资源

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