Royal Hospital for Sick Children Edinburgh, UK.
Resuscitation. 2013 Feb;84(2):218-22. doi: 10.1016/j.resuscitation.2012.06.027. Epub 2012 Jul 11.
The introduction of a paediatric medical emergency team (pMET) was accompanied by integration of weekly in situ simulation team training into routine clinical practice. On a rotational basis, all key ward staff participated in team training, which focused on recognition of the deteriorating child, teamwork and early consultant review of patients with evolving critical illness. This study aimed to evaluate the impact of regular team training on the hospital response to deteriorating in-patients and subsequent patient outcome.
Prospective cohort study of all deteriorating in-patients of a tertiary paediatric hospital requiring admission to paediatric intensive care (PICU) the year before, and after, the introduction of pMET and concurrent team training.
Deteriorating patients were: recognised more promptly (before/after pMET: median time 4/1.5 h, p<0.001), more often reviewed by consultants (45%/76%, p=0.004), more often transferred to high dependency care (18%/37%, p=0.021) and more rapidly escalated to intensive care (median time 10.5/5 h, p=0.024). These improved responses by ward staff extended beyond direct involvement of pMET. There was a trend towards fewer PICU admissions, reduced level of sickness at the time of PICU admission, reduced length of PICU stay and reduced PICU mortality. Introduction of pMET coincided with significantly reduced hospital mortality (p<0.001).
These results indicate that lessons learnt by ward staff during regular in situ team training led to significantly improved recognition and management of deteriorating in-patients with evolving critical illness. Integration of in situ simulation team training in clinical care has potential applications beyond paediatrics.
引入儿科医疗应急小组（pMET）的同时，将每周现场模拟团队培训纳入常规临床实践。所有关键病房工作人员都轮流参加团队培训，重点是识别病情恶化的儿童、团队合作以及对病情不断恶化的患者进行早期顾问审查。本研究旨在评估定期团队培训对医院对恶化住院患者的反应以及随后患者结局的影响。
对引入 pMET 前后一年中需要入住儿科重症监护病房（PICU）的所有恶化住院患者进行前瞻性队列研究。
恶化的患者得到了更及时的识别（引入 pMET 前后：中位数时间为 4/1.5 小时，p<0.001），更多地接受顾问审查（45%/76%，p=0.004），更多地转至高度监护病房（18%/37%，p=0.021），更快地转入重症监护病房（中位数时间为 10.5/5 小时，p=0.024）。病房工作人员的这些反应得到了改善，超出了 pMET 的直接参与。趋势是 PICU 入院人数减少，PICU 入院时的疾病严重程度降低，PICU 住院时间缩短，PICU 死亡率降低。引入 pMET 与医院死亡率显著降低相关（p<0.001）。
这些结果表明，病房工作人员在常规现场团队培训中学到的经验教训导致对病情不断恶化的恶化住院患者的识别和管理得到显著改善。将现场模拟团队培训融入临床护理具有超越儿科的潜在应用。
