Smith Patricia L, McSweeney Jean
Jt Comm J Qual Patient Saf. 2017 Jun;43(6):289-298. doi: 10.1016/j.jcjq.2017.01.006. Epub 2017 Mar 21.
Many hospitals use rapid response teams (RRTs) to respond to deteriorating patients, but it remains unclear what organizations actually monitor. Understanding what organizations value in an RRT may help clarify measurement choices. Interviews were conducted to determine how organizational leaders perceived and evaluated their hospitals' RRTs.
The study used a descriptive, qualitative design. Participants were nurse executives and key informants in 300- to 500-bed hospitals in the south-central United States and were recruited using purposive and snowball sampling. Sample size was determined by data saturation. Semistructured face-to-face interviews were audio-recorded and transcribed. Interview data were analyzed using the techniques of conventional content analysis and constant comparison and descriptive statistics for demographics.
From November 2014 through April 2015, 27 participants were interviewed from 15 hospitals. Global themes emerged: value of and monitoring the RRT. All participants valued positive patient outcomes from use of the RRT, such as decreased code rates and transfers to the ICU. They also valued positive influences of the RRT on the health care team such as education, relationships, and promotion of a culture of safety, including providing consistency of care and evidence-based care. Formal and informal RRT evaluations were usually conducted, resulting in subsequent actions.
Participants emphasized the impact of the RRT on professional staff relationships and the organizational culture, suggesting that the actual value of the RRT stretches beyond patient outcomes. Evaluations of the RRTs were largely informal. Hospitals placed high value on health care team and organizational outcomes but generally did not capture data to support them.
许多医院使用快速反应小组（RRT）来应对病情恶化的患者，但目前尚不清楚各机构实际监测的内容。了解各机构在快速反应小组中所重视的方面可能有助于明确衡量标准的选择。我们进行了访谈，以确定组织领导者如何看待和评估他们医院的快速反应小组。
本研究采用描述性定性设计。参与者为美国中南部拥有300至500张床位医院的护士管理人员和关键信息提供者，采用立意抽样和滚雪球抽样的方法进行招募。样本量由数据饱和情况决定。半结构化面对面访谈进行了录音和转录。访谈数据采用常规内容分析法、持续比较法以及人口统计学描述性统计方法进行分析。
2014年11月至2015年4月，对来自15家医院的27名参与者进行了访谈。出现了一些总体主题：快速反应小组的价值和监测。所有参与者都重视使用快速反应小组带来的积极患者结局，如降低心肺复苏率和转入重症监护病房的比例。他们还重视快速反应小组对医疗团队的积极影响，如教育、人际关系以及促进安全文化，包括提供护理的一致性和循证护理。通常会进行正式和非正式的快速反应小组评估，并随之采取后续行动。
参与者强调了快速反应小组对专业人员关系和组织文化的影响，这表明快速反应小组的实际价值超出了患者结局。对快速反应小组的评估大多是非正式的。医院高度重视医疗团队和组织结局，但通常没有收集数据来支持这些方面。
