Department of Surgery, Trauma Surgery and Critical Care, Boston University, Boston, MA, United States.
Resuscitation. 2013 Mar;84(3):276-9. doi: 10.1016/j.resuscitation.2012.06.022. Epub 2012 Jul 6.
Rapid response systems (RRS) evolved to care for deteriorating hospitalized patients outside of the ICU. However, emergent critical care needs occur suddenly and unexpectedly throughout the hospital campus, including areas with non-hospitalized persons. The efficacy of RRS in this population has not yet been described or tested. We hypothesize that non-hospitalized patients accrue minimal benefit from ICU physician participation in the RRS.
A retrospective review of all RRS events in non-hospitalized patients for a 28 month period was performed in a large, urban university medical center. Location, patient type and age, activation trigger, interventions performed, duration of event and disposition were recorded. Admission diagnosis and length of stay were also recorded for patients admitted to the hospital.
Academic medical center.
Non-hospitalized persons requiring evaluation by the medical emergency team.
None.
There were a total of 1778 RRS activations during the study period. 232 (13%) of activations were for non-hospitalized patients. The patient cohort consisted of outpatients, visitors, and staff. Triggers for RRS activation were neurologic change (42%), cardiac (27%), respiratory (16%), and staff concerns (16%). The mean duration of the response was 38 min. The most common interventions performed included administration of oxygen (46%), intravenous fluids (13%) and dextrose (6%). 82% of patients were taken to the emergency department and 32% of the ED cohort were admitted to the hospital.
Perceived emergencies in non-hospitalized patients occur commonly but require minimal emergent intervention. Restriction of critical care physician involvement to inpatient deteriorations should be considered when designing a RRS. Future studies are needed to evaluate the utility of non-physician provider led rapid response teams with protocol-driven interventions for similar populations.
快速反应系统（RRS）的发展是为了在 ICU 之外照顾病情恶化的住院患者。然而，紧急的重症监护需求会突然出现在医院园区的各个区域，包括非住院患者所在的区域。RRS 在这一人群中的效果尚未得到描述或测试。我们假设 ICU 医生参与 RRS 对非住院患者的益处很小。
对一家大型城市大学医学中心 28 个月期间所有非住院患者的 RRS 事件进行了回顾性研究。记录了事件发生的地点、患者类型和年龄、激活触发因素、实施的干预措施、事件持续时间和转归。还记录了住院患者的入院诊断和住院时间。
学术医疗中心。
需要接受医疗急救小组评估的非住院患者。
无。
在研究期间共发生了 1778 次 RRS 激活。其中 232 次（13%）为非住院患者。患者队列包括门诊患者、访客和员工。RRS 激活的触发因素为神经变化（42%）、心脏（27%）、呼吸（16%）和员工关注（16%）。反应的平均持续时间为 38 分钟。最常实施的干预措施包括给予氧气（46%）、静脉输液（13%）和葡萄糖（6%）。82%的患者被送往急诊科，急诊科患者中有 32%被收治住院。
非住院患者中出现的紧急情况很常见，但需要的紧急干预很少。在设计 RRS 时，应考虑将重症监护医生的参与仅限于住院患者的病情恶化。需要进一步研究评估类似人群中由非医师主导的快速反应团队与基于协议的干预措施的效用。
