Experience with an in-hospital emergency service in a large hospital

Background and Objective: Many hospitals have a special resuscitation servi ce that is responsible for life-threatening emergencies outside the hospita ls intensive care unit, i.e. in the wards and in patient-treatment areas. I n contrast, there is generally no emergency service caring for patients, vi sitors or personnel outside of these areas. In order to provide emergency m edical help in the entire hospital area, in 1999 we instituted an additiona l in-hospital emergency service to cover the larger hospital area. This pap er describes the structure of our in-hospital emergency service and our exp erience in the first 26 months after its establishment. Patients and Methods: We analysed the emergency protocols of all 147 episod es, that had occurred within the first 26 months. We classified them accord ing to type of disease and/or injury by using the NACA score (range 1 to 7) to assess the severity of disease and/or injury. Results: 45 episodes took place within one of the 17 hospital buildings. 92 requests for help came from the hospital service and treatment areas inclu ding walkways and passages, while 3 came from the immediate vicinity outsid e of the hospital. A total of 7 requests turned out to be pranks, and 31.3% responses proved to be unnecessary when the team arrived at the scene. Of the total of 125 treated cases, 30 had a NACA score between 4 and 6, denoti ng life-threatening injury and/or disease. 6 patients were found dead at th e scene or died shortly after arrival of the team. 101 of the patients had to be admitted to the hospital's emergency room. Conclusion: Since its establishment, knowledge of the existence of our in-h ospital emergency service has steadily increased within the hospital commun ity. As a consequence, number of events have likewise steadily increased. W e believe that a total of 20.4% life-threatening events underscores the imp ortance of the service in our large and extended hospital area. We also fee l that our adherence to the training and personnel requirements demanded of public emergency services is necessary in order to insure the quality and efficacy of the service. This is also important because of current intentio ns to use our in-hospital service as a back-up and/or reserve for the commu nity's public emergency services.