夜间重症监护室出院的后果
1Intensive Care National Audit & Research Centre, London, UK.
Lancet (London, England)
|May 3, 2000
概括
在英国,重症监护室 (ICU) 的夜间出院人数正在增加,并且与患者的治疗结果更差有关. 这一趋势表明潜在的床位短缺,需要仔细考虑资源配置.
科学领域:
- 临界护理医学 临界护理医学
- 医疗保健服务研究 医疗服务研究
- 医院管理 医院管理
背景情况:
- 在英国,重症监护室 (ICU) 的病床压力越来越令人担忧.
- 夜间的排出被用作评估ICU床压力的代理.
- 之前的研究并没有广泛探讨夜间排放的影响.
研究的目的:
- 调查英国ICU夜间出院的趋势.
- 为了比较晚上出院的患者和白天出院的患者的结果.
- 检查夜间出院,早出院和医院死亡率之间的关系.
主要方法:
- 定义"夜间"为"办公时间外" (2200-0659小时) 和"凌晨" (0000-0459小时).
- 在1988-90年 (26 ICU,10806人) 和1995-98年 (62 ICU,21295人) 之间的夜间排放率进行了比较.
- 分析了夜间和早产的后果,仅使用1995-98年的数据.
主要成果:
- 晚上 (2200-0659小时) 出院的ICU幸存者的比例从2.7% (1988-90) 增加到6.0% (1995-98).
- 晚上出院的患者 (2200-0659小时) 的最终医院死亡率更高 (原始OR为1.46,调整为1.33).
- 早出院在夜间更常见 (42.6%对5.0%),并且与死亡率 (OR 1.35) 有显著的关联.
结论:
- 英国重症监护室的夜间出院人数正在增加,并与患者的治疗结果明显恶化有关.
- 夜间出院更有可能被临床医生认为是"过早"的.
- 夜间排放的增加可能表明ICU床位容量不足,需要评估资源配置和成本效益.
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