Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Ann Intern Med. 2013 Mar 5;158(5 Pt 2):417-25. doi: 10.7326/0003-4819-158-5-201303051-00009.
Rapid-response systems (RRSs) are a popular intervention in U.S. hospitals and are supported by accreditors and quality improvement organizations. The purpose of this review is to evaluate the effectiveness and implementation of these systems in acute care settings. A literature search was performed between 1 January 2000 through 30 October 2012 using PubMed, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials. Studies published in any language evaluating outcome changes that occurred after implementing an RRS and differences between groups using and not using an RRS (effectiveness) or describing methods used by RRSs (implementation) were reviewed. A single reviewer (checked by a second reviewer) abstracted data and rated study quality and strength of evidence. Moderate-strength evidence from a high-quality meta-analysis of 18 studies and 26 lower-quality before-and-after studies published after that meta-analysis showed that RRSs are associated with reduced rates of cardiorespiratory arrest outside of the intensive care unit and reduced mortality. Eighteen studies examining facilitators of and barriers to implementation suggested that the rate of use of RRSs could be improved.
快速反应系统（RRS）在美国医院中是一种很受欢迎的干预措施，受到认证机构和质量改进组织的支持。本综述的目的是评估这些系统在急性护理环境中的有效性和实施情况。使用 PubMed、PsycINFO、CINAHL 和 Cochrane 对照试验中心注册库，于 2000 年 1 月 1 日至 2012 年 10 月 30 日进行了文献检索。评估了实施 RRS 后发生的结果变化，并比较了使用和不使用 RRS 的组之间的差异（有效性），或描述 RRS 使用方法（实施）的研究。一位审查员（由第二位审查员检查）提取数据并评估研究质量和证据强度。高质量荟萃分析的 18 项研究和该荟萃分析之后发表的 26 项较低质量的前瞻性研究的中等强度证据表明，RRS 与减少重症监护病房外的心肺骤停发生率和降低死亡率相关。18 项研究检查了实施的促进因素和障碍，表明 RRS 的使用率可以提高。
