Johnston Maximilian J, Arora Sonal, King Dominic, Bouras George, Almoudaris Alex M, Davis Rachel, Darzi Ara
Centre for Patient Safety and Service Quality, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK.
Centre for Patient Safety and Service Quality, Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK.
Surgery. 2015 Apr;157(4):752-63. doi: 10.1016/j.surg.2014.10.017.
The relationship between the ability to recognize and respond to patient deterioration (escalate care) and its role in preventing failure to rescue (FTR; mortality after a surgical complication) has not been explored. The aim of this systematic review was to determine the incidence of, and factors contributing to, FTR and delayed escalation of care for surgical patients.
A search of MEDLINE, EMBASE PsycINFO, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials was conducted to identify articles exploring FTR, escalation of care, and interventions that influence outcomes. Screening of 19,887 citations led to inclusion of 42 articles.
The reported incidence of FTR varied between 8.0 and 16.9%. FTR was inversely related to hospital volume and nurse staffing levels. Delayed escalation occurred in 20.7-47.1% of patients and was associated with greater mortality rates in 4 studies (P < .05). Causes of delayed escalation included hierarchy and failures in communication. Of five interventional studies, two reported a significant decrease in intensive care admissions (P < .01) after introduction of escalation protocols; only 1 study reported an improvement in mortality.
This systematic review explored factors linking FTR and escalation of care in surgery. Important factors that contribute to the avoidance of preventable harm include the recognition and communication of serious deterioration to implement definitive treatment. Targeted interventions aiming to improve these factors may contribute to enhanced patient outcome.
识别患者病情恶化并做出反应（加强护理）的能力与其在预防抢救失败（手术后并发症导致的死亡）中的作用之间的关系尚未得到探讨。本系统评价的目的是确定手术患者抢救失败及护理延迟升级的发生率和相关因素。
检索MEDLINE、EMBASE、PsycINFO、Cochrane系统评价数据库和Cochrane对照试验中心注册库，以识别探讨抢救失败、护理升级及影响结局的干预措施的文章。对19887篇文献进行筛选，最终纳入42篇文章。
报道的抢救失败发生率在8.0%至16.9%之间。抢救失败与医院规模和护士配备水平呈负相关。20.7%至47.1%的患者出现护理延迟升级，4项研究表明护理延迟升级与更高的死亡率相关（P < 0.05）。护理延迟升级的原因包括等级制度和沟通失误。在5项干预性研究中，2项研究报告在引入升级方案后重症监护入院人数显著减少（P < 0.01）；只有1项研究报告死亡率有所改善。
本系统评价探讨了手术中与抢救失败和护理升级相关的因素。有助于避免可预防伤害的重要因素包括识别严重病情恶化并进行沟通以实施确定性治疗。旨在改善这些因素的针对性干预措施可能有助于改善患者结局。
