German in-hospital emergency registry: A two years analysis

Abstract

Introduction: Since January 2013, the German Resuscitation Registry database includes – in addition to in-hospital resuscitation (51 participating hospitals) – also data on in-hospital emergency management (38 hospitals). To date the data base contains 5252 data sets. Methods: Registry data were collected anonymously and subsequently analysed. Results: The medical emergency team (MET) was called for resuscitation 2802 times. Circulatory arrest was due to cardiac conditions in 55.4% (n=1552) and respiratory conditions in 23.6% (n=660). Sepsis, bleeding and metabolic derangement were less than 5%. ROSC was achieved in 1753 patients (62.6%), 12% going homewith good neurological function. Most frequent locations for CPR were the ward (55%), IMC/ICU (18%), and emergency room (13%). 487 patients (19%) had no independent life before resuscitation, 63% of patients (1662) presentedwith significant pre-existing conditions (PC). 15% of patients were healthy or has minor limitations. 2450 times the MET was called to in-hospital emergency management without resuscitation. Such emergency situations occurred 1056 time (43.2%) on the ward, 368 time (15%) in the diagnostic suite and 429 time (17.5%) somewhere else on the hospital premises. The most frequent indications for emergency calls were respiratory compromise (n=973) hemodynamic instability (n=921) and neurological deterioration (n=677). 231 patients (10.6%) had no independent life before this emergency, 50.9% of patients (n=1113) presented with significant pre-existing conditions. All participating hospitals receive a yearbook with a thorough analysis of more than 100 variables including benchmarking. Discussion and conclusion: In half of hospitals, emergency teams are requested for resuscitation only. Actually, such teams should be called way before CPR becomes necessary, to initiate preventive measures. All in-hospital patients should receive vital-signs monitoring, appropriate for the severity of their condition. In Germany, structures need to be established to actually obviate the need for CPR and eliminate unexpected deaths; such structures should include early warning scores and standardized alarm criteria. The German in-hospital registry is a tool for quality improvement in patient safety and treatment.