Subbe Christian P, Kellett John, Barach Paul, Chaloner Catriona, Cleaver Hayley, Cooksley Tim, Korsten Erik, Croke Eilish, Davis Elinor, De Bie Ashley Jr, Durham Lesley, Hancock Chris, Hartin Jilian, Savijn Tracy, Welch John
Ysbyty Gwynedd & Bangor University, Penrhosgarnedd, Bangor, LL57 2PW, UK.
Nenagh Hospital, Nenagh, Ireland.
BMC Health Serv Res. 2017 May 8;17(1):334. doi: 10.1186/s12913-017-2288-y.
'Failure to rescue' of hospitalized patients with deteriorating physiology on general wards is caused by a complex array of organisational, technical and cultural failures including a lack of standardized team and individual expected responses and actions. The aim of this study using a learning collaborative method was to develop consensus recomendations on the utility and effectiveness of checklists as training and operational tools to assist in improving the skills of general ward staff on the effective rescue of patients with abnormal physiology.
A scoping study of the literature was followed by a multi-institutional and multi-disciplinary international learning collaborative. We sought to achieve a consensus on procedures and clinical simulation technology to determine the requirements, develop and test a safe using a checklist template that is rapidly accessible to assist in emergency management of common events for general ward use.
Safety considerations about deteriorating patients were agreed upon and summarized. A consensus was achieved among an international group of experts on currently available checklist formats performing poorly in simulation testing as first responders in general ward clinical crises. The Crisis Checklist Collaborative ratified a consensus template for a general ward checklist that provides a list of issues for first responders to address (i.e. 'Check In'), a list of prompts regarding common omissions (i.e. 'Stop & Think'), and, a list of items required for the safe "handover" of patients that remain on the general ward (i.e. 'Check Out'). Simulation usability assessment of the template demonstrated feasibility for clinical management of deteriorating patients.
Emergency checklists custom-designed for general ward patients have the potential to guide the treatment speed and reliability of responses for emergency management of patients with abnormal physiology while minimizing the risk of adverse events. Interventional trials are needed.
普通病房中生理状况恶化的住院患者的“未能挽救”是由一系列复杂的组织、技术和文化失误导致的，包括缺乏标准化的团队及个人预期反应和行动。本研究采用学习协作方法，旨在就清单作为培训和操作工具的效用和有效性达成共识建议，以帮助提高普通病房工作人员有效抢救生理异常患者的技能。
在对文献进行范围研究之后，开展了一项多机构、多学科的国际学习协作。我们力求就程序和临床模拟技术达成共识，以确定要求，使用一份可快速获取的清单模板进行开发和测试，该模板有助于普通病房对常见事件进行应急管理。
就有关病情恶化患者的安全考量达成了一致意见并进行了总结。国际专家小组就普通病房临床危机中作为第一反应者在模拟测试中表现不佳的现有清单格式达成了共识。危机清单协作组织批准了一份普通病房清单的共识模板，该模板提供了供第一反应者处理的问题清单（即“签到”）、关于常见遗漏的提示清单（即“停下来思考”）以及普通病房中留治患者安全“交接”所需的项目清单（即“签出”）。对该模板的模拟可用性评估表明其对病情恶化患者的临床管理具有可行性。
为普通病房患者量身定制的应急清单有可能指导对生理异常患者进行应急管理时的治疗速度和反应可靠性，同时将不良事件风险降至最低。需要进行干预试验。
