Lakshminarayana Pradeep H, Darby Joseph M, Simmons Richard L
From the *Department of Critical Care Medicine, University of Pittsburgh Medical Center, Presbyterian Hospital; and †Department of Surgery, University of Pittsburgh; Corporate Risk Management, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Patient Saf. 2017 Mar;13(1):14-19. doi: 10.1097/PTS.0000000000000098.
Rapid response teams (RRTs) have been widely accepted as useful adjuncts to the care of inpatients with unanticipated emergencies. One study suggested that leadership of such teams could be assigned to midlevel providers, especially when nonhospitalized person (NHP)-related emergencies occur. However, in our tertiary medical center, a critical care medicine (CCM) physician always leads all RRT events including those related to NHPs.
In this study, we postulate reasons in favor of a single structured RRT led by an intensivist for both inpatients and NHPs.
An observational study conducted at an academic medical center. Demographic and clinical characteristics of NHP-related RRT events were evaluated over a 9-month period.
Rapid response teams were activated 1,952 times, of which, 154 events were NHP related. Only 42 RRT activations occurred for employees and visitors. Most of the NHP activations (112 events) occurred in response to events involving persons who were on the premises because of preexisting illnesses, either visiting physician offices (46 events), undergoing ambulatory diagnostic procedures (30 events), in transit to the emergency department (13 events), or undergoing emergency psychiatry evaluation (11 events). Most patients (83 NHPs) required admission to the hospital including 22 NHPs to intensive care units (ICUs) either directly from the event location or subsequently from the emergency department. The physician team leader admitted 20 NHPs directly from the scene, of which, 13 were admitted directly to ICUs.
Nonhospitalized patients requiring RRT activation often have complex pre-existent illnesses. A standardized team composition for both inpatients and NHPs in crisis is an appropriate administrative structure enhancing patient safety in hospitals where ambulatory and inpatient facilities are combined.
快速反应小组（RRTs）已被广泛认可为护理意外紧急情况住院患者的有用辅助手段。一项研究表明，此类小组的领导工作可分配给中级医疗人员，尤其是在发生与非住院人员（NHP）相关的紧急情况时。然而，在我们的三级医疗中心，重症医学（CCM）医生始终领导所有RRT事件，包括与NHP相关的事件。
在本研究中，我们推测由重症监护医生领导针对住院患者和NHP的单一结构化RRT的理由。
在一家学术医疗中心进行的观察性研究。在9个月的时间里评估了与NHP相关的RRT事件的人口统计学和临床特征。
快速反应小组被激活1952次，其中154次事件与NHP相关。员工和访客仅有42次RRT激活。大多数NHP激活事件（112次）是针对因既往疾病在院的人员所发生的事件做出的反应，这些人员要么在就诊医师办公室（46次）、接受门诊诊断程序（30次）、前往急诊科途中（13次），要么正在接受急诊精神病学评估（11次）。大多数患者（83名NHP）需要住院治疗，其中22名NHP直接从事件发生地点或随后从急诊科转入重症监护病房（ICU）。医师团队负责人直接从现场收治了20名NHP，其中13名直接入住ICU。
需要激活RRT的非住院患者通常有复杂的既往疾病。在门诊和住院设施合并的医院中，为住院患者和处于危机中的NHP制定标准化的团队组成是一种适当的管理结构，可提高患者安全性。
