建置早期警訊系統降低院內急救事件發生率

Early warning systems to reduce the rate of cardiopulmonary resuscitation events

背景：院內心跳停止（in-hospital cardiac arrest，IHCA）在事件發生前數小時會出現臨床症狀及生命徵象（Temperature , pulse ,Respiration，TPR）惡化現象，發展早期警訊系統（Early Warning System，EWS）可及早提醒醫護人員病況改變，增進醫療照護成效。目的：藉由早期警訊系統，幫助醫療團隊早期發現病情惡化並給予立即處置，以降低院內心跳停止發生率，以提升醫療照護品質，促進病人安全。方法：:建置「早期警訊系統」（EWS）包含高危險病人早期警訊系統啟動標準及臨床運作流程。經內外科各一種子單位測試後，全院所有內、外科病房進行高危險病人早期警訊系統資訊化作業。結果：比較2013及2014年資料顯示院內急救事件發生人次由75人次降至42人次，院內急救事件發生人數與住院人數比由2.44降至1.48，院內急救事件病人死亡率由34.7％上升至42.9％，院內急救事件病人出院存活率由27.9％提升至34.9％。結論：透過早期警訊系統偵測及反應，讓醫護人員提早發現高危險病人，避免及減少因院內心跳停止導致之急救事件發生，降低醫護工作量及相關醫療費用支出。 Background: Adverse events, such as in-hospital cardiac arrest, can be predicted through abnormalvital signs several hours before the events occur. Early warning systems (EWSs)can help medicalprofessionals to identify significant changes in patients’ health status and thus improve health carequality. In addition, setting up EWSs may reduce the cardiopulmonary resuscitation (CPR)event rateand increase patient safety.Methods: We established a early warning system (EWS) with early warning systems startup criteriaand clinical operation process for high-risk patients . After testing each one internal and surgeryunit. And all internal and surgical wards of the hospital was implemented of the early warningsystems for high-risk patients.Results: From 2013 to 2014, the number of patients receiving CPRdecreased from 75 to 42, CPReventrate decreased from 2.44‰ to 1.48‰, mortality rate is increased from34.7% to 42.9%, andsurvival rate is increased from 27.9% to 34.9%.Conclusion: EWSs reduced the CPR event ratebut increased the survival rate. Thus, EWSs canreduce healthcare professionals’ workload and medical costs and enhance medical carequality.