Gill Fenella J, Leslie Gavin D, Marshall Andrea P
NHMRC TRIP Fellow, School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Curtin University, and Nurse Researcher, Princess Margaret Hospital for Children, Child & Adolescent Health Services, Perth, Western Australia, Australia.
Professor Critical Care Nursing, Director Research & Development, School of Nursing, Midwifery & Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
Worldviews Evid Based Nurs. 2016 Aug;13(4):303-13. doi: 10.1111/wvn.12168. Epub 2016 Jun 3.
Rapid response systems incorporate concepts of early recognition of patient deterioration, prompt reporting, and response which result in escalation of patient care. The ability to initiate escalation of care is now being extended to families of hospitalized patients.
To identify the impact of implementation of family-initiated escalation of care for the deteriorating patient in hospital?
A systematic review of peer-reviewed publications was conducted. Databases were searched from January 2005 to May 2015 for articles reporting the implementation and evaluation of family involvement programs. Reference lists of retrieved articles were searched.
Ten articles (all descriptive studies) reported implementation and evaluation of response systems for patients and families to trigger an alert for help; five described a triaged response; five reported systems for families to directly activate the rapid response team. Five articles reported implementation in the pediatric setting. There were a total of 426 family-initiated calls, range 0.17 to 11 per month, with no deaths reported. All calls were deemed to be appropriate and three calls resulted in intensive care unit admissions. The basis of patient- or family-initiated calls stemmed from communication or systems breakdown. The large range in frequency of calls was associated with the process implemented, the strategies used and the calling criteria (up to four). Feedback from families was positive. There appeared to be a level of staff stress associated with introducing this process.
A variety of practice models and calling criteria were reported to either directly activate an existing rapid response team or trigger a separate response to patient- or family-initiated calls. The broader calling criteria and more comprehensive implementation strategies were associated with more patient- and family-initiated escalation of care calls. There is no systematically researched evidence to assess the value of family-initiated calls for deteriorating patients.
快速反应系统包含对患者病情恶化的早期识别、及时报告和响应等概念，这些会促使患者护理级别提升。如今，启动护理级别提升的能力已扩展至住院患者的家属。
确定在医院实施家属启动的护理级别提升对病情恶化患者的影响？
对同行评审出版物进行系统综述。检索2005年1月至2015年5月的数据库，查找报告家属参与项目实施与评估的文章。检索所获文章的参考文献列表。
十篇文章（均为描述性研究）报告了针对患者及家属触发求助警报的反应系统的实施与评估；五篇描述了分诊反应；五篇报告了家属直接启动快速反应团队的系统。五篇文章报告了在儿科环境中的实施情况。家属发起的呼叫共有426次，每月呼叫次数范围为0.17至11次，无死亡报告。所有呼叫均被认为是恰当的，三次呼叫导致患者入住重症监护病房。患者或家属发起呼叫的原因源于沟通或系统故障。呼叫频率差异较大与实施的流程、使用的策略及呼叫标准（多达四条）有关。家属的反馈是积极的。引入此流程似乎给工作人员带来了一定程度的压力。
据报告，各种实践模式和呼叫标准可直接启动现有的快速反应团队，或对患者或家属发起的呼叫触发单独反应。更宽泛的呼叫标准和更全面的实施策略与更多患者及家属发起的护理级别提升呼叫相关。尚无系统研究证据来评估家属发起的呼叫对病情恶化患者的价值。
