Silverman Institute for Healthcare Quality and Safety, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Crit Care Med. 2012 Sep;40(9):2562-8. doi: 10.1097/CCM.0b013e318259007b.
Laws and regulations require many hospitals to implement rapid-response systems. However, the optimal resource intensity for such systems is unknown. We sought to determine whether a rapid-response system that relied on a patient's usual care providers, not a critical-care-trained rapid-response team, would improve patient outcomes.
DESIGN, SETTING, AND PATIENTS: An interrupted time-series analysis of over a 59-month period.
Urban, academic hospital.
One hundred seven-one thousand, three hundred forty-one consecutive adult admissions.
In the intervention period, patients were monitored for predefined, standardized, acute, vital-sign abnormalities or marked nursing concern. If these criteria were met, a team consisting of the patient's existing care providers was assembled.
The unadjusted risk of unexpected mortality was 72% lower (95% confidence interval 55%-83%) in the intervention period (absolute risk: 0.02% vs. 0.09%, p < .0001). The unadjusted in-hospital mortality rate was not significantly lower (1.9% vs. 2.1%, p = .07). After adjustment for age, gender, race, season of admission, case mix, Charlson Comorbidity Index, and intensive care unit bed capacity, the intervention period was associated with an 80% reduction (95% confidence interval 63%-89%, p < .0001) in the odds of unexpected death, but no significant change in overall mortality [odds ratio 0.91 (95% confidence interval 0.82-1.02), p = .09]. Analyses that also adjusted for secular time trends confirmed these findings (relative risk reduction for unexpected mortality at end of intervention period: 65%, p = .0001; for in-hospital mortality, relative risk reduction = 5%, p = .2).
A primary-team-based implementation of a rapid response system was independently associated with reduced unexpected mortality. This system relied on the patient's usual care providers, not an intensive care unit based rapid response team, and may offer a more cost-effective approach to rapid response systems, particularly for systems with limited intensivist availability.
法律和法规要求许多医院实施快速反应系统。然而，这种系统的最佳资源强度尚不清楚。我们试图确定一种依赖于患者常规护理提供者而不是重症监护训练有素的快速反应团队的快速反应系统是否会改善患者的预后。
设计、设置和患者：超过 59 个月的时间序列分析。
城市，学术医院。
连续 1071341 名成年住院患者。
在干预期间，对患者进行了预先设定的、标准化的、急性的、生命体征异常或明显护理关注的监测。如果符合这些标准，将组建一个由患者现有护理提供者组成的团队。
在干预期间，未预料到的死亡率风险降低了 72%（95%置信区间为 55%-83%）（绝对风险：0.02% vs. 0.09%，p <.0001）。未调整的院内死亡率没有显著降低（1.9% vs. 2.1%，p =.07）。在调整年龄、性别、种族、入院季节、病例组合、Charlson 合并症指数和重症监护病房床位容量后，干预期间与未预料到的死亡风险降低 80%相关（95%置信区间为 63%-89%，p <.0001），但总体死亡率无显著变化[比值比 0.91（95%置信区间为 0.82-1.02），p =.09]。还调整了时间趋势的分析证实了这些发现（干预结束时未预料到的死亡率的相对风险降低：65%，p =.0001；对于院内死亡率，相对风险降低= 5%，p =.2）。
以初级团队为基础实施快速反应系统与降低未预料到的死亡率独立相关。该系统依赖于患者的常规护理提供者，而不是重症监护病房为基础的快速反应团队，并且可能为快速反应系统提供更具成本效益的方法，特别是对于重症监护医生资源有限的系统。
