快速應變團隊對住院死亡率的影響

Abstract

目的：許多研究對醫院導入快速應變團隊是否能降低住院死亡發生率有不同結論。此研究目的為進一步探討快速應變團隊對住院死亡發生率的影響。材料與方法：本研究為品質改善專案前後對照研究，資料收集來源自單一醫院之一般病房成人病人，收集時間自2014年01月至2019年12月，統計分析使用普通最小平方法。結果：未導入快速應變團隊期間，一般病房住院死亡率（不包含DNR病人）為0.47%，而完全導入快速應變團隊後，死亡率降至0.2%，降幅達到顯著水準。同時，未導入快速應變團隊前非預期心跳停止發生率為0.07%，而完全導入快速應變團隊後，非預期心跳停止發生率降至0.03%，降幅同樣達到顯著水準。然而，一般病房住院病人總死亡率（包含DNR病人）並無因為導入快速應變團隊而改善。結論：完整導入快速應變系統不能降低一般病房住院病人總死亡率，但能降低不包含DNR之一般病房病人住院死亡率與非預期心跳停止發生率。  Purpose: Studies have reported controversial results regarding the effect of rapid response teams (RRTs) on decreasing in-hospital mortality. Therefore, we conducted a study to investigate whether the complete implementation of RRT can decrease in-hospital mortality rates and the incidence of unexpected cardiac arrests in the hospital. Materials and Methods: This before-and-after study collected data from a single hospital between January 2014 and December 2019. We evaluated the differences in in-hospital mortality rates and the incidence of unexpected cardiac arrest before and after the complete implementation of an RRT in the hospital. Results: The in-hospital mortality rate [excluding patients with do-not-resuscitate (DNR) orders] decreased from 0.47% to 0.2% after complete implementation of the RRT, achieving a statistically signifi diff Furthermore, the incidence of unexpected cardiac arrests decreased from 0.07% to 0.03% after the complete implementation of the RRT. However, the overall in-hospital mortality rate (including DNR patients) exhibited no statistically signifi diff after RRT implementation. Conclusion: The complete implementation of an RRT did not decrease the overall in-hospital mortality rate but did decrease the in-hospital mortality rate (excluding DNR patients) and the incidence of unexpected cardiac arrests in the hospital.