Jones D, Hicks P, Currey J, Holmes J, Fennessy G J, Hillman K, Psirides A, Rai S, Singh M Y, Pilcher D V, Bhonagiri D, Hart G K, Fugaccia E
DEPM, Monash University and Intensive Care Unit, Austin Health, Melbourne, Victoria.
Intensive Care Unit, The Wellington Regional Hospital, Wellington, New Zealand.
Anaesth Intensive Care. 2015 May;43(3):369-79. doi: 10.1177/0310057X1504300314.
Rapid Response Teams (RRTs) are specialised teams introduced into hospitals to improve the outcomes of deteriorating ward patients. Although Rapid Response Systems (RRSs) were developed by the intensive care unit (ICU) community, there is variability in their delivery, and consultant involvement, supervision and leadership appears to be relatively infrequent. In July 2014, the Australian and New Zealand Intensive Care Society (ANZICS) convened the first conference on the role of intensive care medicine in RRTs in Australia and New Zealand. The conference explored RRSs in the broader role of patient safety, resourcing and staffing of RRTs, effect on ICU workload, different RRT models, the outcomes of RRT patients and original research projects in the area of RRSs. Issues around education and training of both ICU registrars and nurses were examined, and the role of team training explored. Measures to assess the effectiveness of the RRS and RRT at the level of health system and hospital, team performance and team effectiveness were discussed, and the need to develop a bi-national ANZICS RRT patient database was presented. Strategies to prevent patient deterioration in the 'pre-RRT' period were discussed, including education of ward nurses and doctors, as well as an overarching governance structure. The role of the ICU in deteriorating ward patients was debated and an integrated model of acute care presented. This article summarises the findings of the conference and presents recommendations on the role of intensive care medicine in RRTs in Australia and New Zealand.
快速反应小组(RRTs)是医院引入的专门团队,旨在改善病情恶化的病房患者的治疗结果。尽管快速反应系统(RRSs)是由重症监护病房(ICU)领域开发的,但其实施存在差异,而且顾问的参与、监督和领导似乎相对较少。2014年7月,澳大利亚和新西兰重症监护学会(ANZICS)召开了首届关于重症医学在澳大利亚和新西兰RRTs中作用的会议。该会议探讨了RRSs在患者安全、RRTs的资源配备和人员配置、对ICU工作量的影响、不同的RRT模式、RRT患者的治疗结果以及RRSs领域的原创研究项目等更广泛作用方面的情况。研究了围绕ICU住院医生和护士的教育与培训问题,并探讨了团队培训的作用。讨论了在卫生系统和医院层面评估RRS和RRT有效性的措施、团队绩效和团队效能,并提出了建立一个澳大利亚和新西兰两国共用的ANZICS RRT患者数据库的必要性。讨论了在“RRT前”阶段预防患者病情恶化的策略,包括对病房护士和医生的教育以及一个总体治理结构。对ICU在病情恶化的病房患者中的作用进行了辩论,并提出了一个急性护理综合模式。本文总结了会议的结果,并就重症医学在澳大利亚和新西兰RRTs中的作用提出了建议。