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Circadian pattern of activation of the medical emergency team in a teaching hospital

机译：在教学医院中激活医疗急救队的昼夜节律模式

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IntroductionHospital medical emergency teams (METs) have been implemented to reduce cardiac arrests and hospital mortality. The timing and system factors associated with their activation are poorly understood. We sought to determine the circadian pattern of MET activation and to relate it to nursing and medical activities.MethodWe conducted a retrospective observational study of the time of activation for 2568 incidents of MET attendance. Each attendance was allocated to one of 48 half-hour intervals over the 24-hour daily cycle. Activation was related nursing and medical activities.ResultsDuring the study period there were 120,000 consecutive overnight medical and surgical admissions. The hourly rate of MET calls was greater during the day (47% of calls in the 10 hours between 08:00 and 18:00), but 53% of the 2568 calls occurred between 18:00 and 08:00 hours. MET calls increased in the half-hour after routine nursing observation, and in the half-hour before each nursing handover. MET service utilization was 1.25 (95% confidence interval [CI] = 1.11–1.52) times more likely in the three 1-hour periods spanning routine nursing handover (P = 0.001). The greatest level of half-hourly utilization was seen between 20:00 and 20:30 (odds ratio [OR] = 1.76, 95% CI = 1.25–2.48; P = 0.001), before the evening nursing handover. Additional peaks were seen following routine nursing observations between 14:00 and 14:30 (OR = 1.53, 95% CI = 1.07–2.17; P = 0.022) and after the commencement of the daily medical shift (09:00–09:30; OR = 1.43, 95% CI = 1.00–2.04; P = 0.049).ConclusionPeak levels of MET service activation occur around the time of routine observations and nursing handover. Our findings raise questions about the appropriate frequency and methods of observation in at-risk hospital patients, reinforce the need for adequately trained medical staff to be available 24 hours per day, and provide useful information for allocation of resources and personnel for a MET service.
机译：简介医院急诊医疗队（METs）已实施，以减少心脏骤停和医院死亡率。与它们的激活相关的时间和系统因素知之甚少。我们试图确定MET激活的昼夜节律模式，并将其与护理和医疗活动联系起来。方法我们对2568例MET出勤事件的激活时间进行了回顾性观察研究。在每天24小时的周期中，每次出勤分配给48个半小时间隔之一。激活与护理和医疗活动有关。结果在研究期间，连续12夜通宵接受医疗和手术入院。白天的每小时MET呼叫率更高（在08:00和18:00之间的10个小时中，有47％的呼叫），但是2568个呼叫中的53％是在18:00和08:00之间发生的。常规护理观察后半小时以及每次护理移交前半小时，MET呼叫次数增加。在常规护理交接的三个1小时内，MET服务利用率是1.25（95％置信区间[CI] = 1.11-1.52）的可能性更高（P = 0.001）。在晚上护理移交之前，半小时使用率的最高水平出现在20:00和20:30之间（赔率[OR] = 1.76，95％CI = 1.25–2.48; P = 0.001）。在14:00至14:30期间进行常规护理观察后（OR = 1.53，95％CI = 1.07–2.17; P = 0.022）以及每日医疗班开始后（09：00–09：30），还会看到其他峰值; OR = 1.43，95％CI = 1.00–2.04; P = 0.049）。结论MET服务激活的峰值水平发生在常规观察和护理移交时间附近。我们的发现提出了有关在危险医院中的患者进行观察的适当频率和方法的疑问，加强了对每天24小时都有训练有素的医务人员的需求，并为MET服务的资源和人员分配提供了有用的信息。

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