Centre for Health Services and Workforce Research, Westmead Hospital, Sydney West Area Health Service, Australia.
J Crit Care. 2011 Dec;26(6):635.e11-8. doi: 10.1016/j.jcrc.2011.03.013. Epub 2011 Jun 23.
The purpose of the study was to evaluate the time taken for delivery of each component of care following patient deterioration and to assess the effect on response times of strategies implemented to improve the system.
A model identifying the sequence of organizational responses following a patient's unexpected clinical deterioration was developed. The time to key events and interventions from initial deterioration was measured for 3 months in 2005 and again in 2006 at a tertiary care hospital with a rapid response team (RRT) in place. Strategies to improve compliance with the RRT system were introduced between the 2 periods.
The number of acute deterioration episodes identified increased (61 episodes in 2005; 154 episodes in 2006), but there was no improvement in response times. The 2 components contributing most frequently to delays were the time for nursing staff to call for assistance and, where needed, for physicians to call for higher-level care. Overall, 26% of episodes in 2006 and 30% in 2005 did not receive medical attention within 30 minutes of acute deterioration.
Significant delays in responding to acute deterioration persist despite strategies to facilitate the functioning of the RRT system. Simple strategies such as policy directives are not sufficient to effect change in complex health care systems.
本研究旨在评估患者病情恶化后每个护理环节所需的时间，并评估为改善系统而实施的策略对响应时间的影响。
开发了一个模型，用于确定患者病情意外恶化后组织反应的顺序。在配备快速反应团队（RRT）的三级护理医院中，于 2005 年和 2006 年的 3 个月内，针对关键事件和干预措施，从最初的恶化开始测量时间。在两个时间段之间引入了提高 RRT 系统合规性的策略。
确定的急性恶化事件数量增加（2005 年有 61 个事件；2006 年有 154 个事件），但响应时间没有改善。导致延迟的两个最常见的因素是护理人员寻求帮助的时间，以及在需要时医生寻求更高层次护理的时间。总体而言，2006 年的 26%和 2005 年的 30%的事件在急性恶化后 30 分钟内没有得到医疗关注。
尽管采取了促进 RRT 系统运作的策略，但对急性恶化的反应仍存在显著延迟。简单的策略，如政策指令，不足以改变复杂的医疗保健系统。
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