Gallo de Moraes Alice, OʼHoro John C, Sevilla-Berrios Ronaldo A, Iacovella Gina, Lenhertz Andrea, Schmidt Julie, Elmer Jennifer, Oeckler Richard, Caples Sean, Jensen Jeffrey B
Division of Pulmonary and Critical Care Medicine (Drs Gallo de Moraes, O'Horo, Iacovella, Oeckler, and Caples) and Departments of Nursing (Mss Lenhertz and Schmidt and Dr Elmer) and Anesthesiology (Dr Jensen), Mayo Clinic, Rochester, Minnesota; and Division of Critical Care, University of Pennsylvania Medical Center-Hamot, Erie (Dr Sevilla-Berrios).
Qual Manag Health Care. 2018 Jan/Mar;27(1):50-55. doi: 10.1097/QMH.0000000000000159.
Rapid response teams (RRTs) were implemented to provide critical care services for deteriorating patients outside of intensive care units. To date, research on RRT has been conflicting, with some studies showing significant mortality benefit and reduction in cardiac arrest events and others showing no benefit. However, studies have consistently showed improved outcomes when RRTs work closely with primary services. Baseline data analysis at our institution found that primary services were present only on 50% of RRT activations. This quality improvement project aimed to improve the presence of primary services during RRT activations by 25%. With a survey, the main barrier that prevented primary services to be present was identified as the primary services' failure to recognize them as a crucial part of the RRT. Education tools and in-person sessions were implemented reinforcing the importance of primary services presence during RRT activations. The intervention leads to increasing presence of primary services at RRT activations, transfers to higher level of care, and changes in code status. However, there was no difference in hospital or intensive care unit length of stay or in survival.
快速反应小组（RRTs）的设立是为了在重症监护病房之外为病情恶化的患者提供重症护理服务。迄今为止，关于RRT的研究结果相互矛盾，一些研究显示其能显著降低死亡率并减少心脏骤停事件，而另一些研究则表明并无益处。然而，研究一直表明，当RRT与基层医疗服务紧密合作时，治疗效果会得到改善。我们机构的基线数据分析发现，在RRT启动时，仅有50%的情况有基层医疗服务人员在场。这个质量改进项目旨在使RRT启动期间基层医疗服务人员在场的比例提高25%。通过一项调查，发现阻碍基层医疗服务人员到场的主要障碍是他们未能认识到自己是RRT的关键组成部分。为此实施了教育工具和面对面培训课程，以强化基层医疗服务人员在RRT启动时到场的重要性。该干预措施使基层医疗服务人员在RRT启动时到场率提高，转至更高护理级别的情况增加，以及临终状态发生了变化。然而，住院时间或重症监护病房住院时间以及生存率并无差异。
