Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of Emergency Medicine, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
Resuscitation. 2018 Aug;129:127-134. doi: 10.1016/j.resuscitation.2018.04.018. Epub 2018 Apr 18.
Deterioration of hospitalised patients is often missed, misinterpreted, and mismanaged. Rapid Response Systems (RRSs) have been proposed to solve this problem. This study aimed to investigate the effect of an RRS on the incidence of unexpected death, cardiac arrest with cardiopulmonary resuscitation (CPR), and unplanned intensive care unit (ICU) admission.
We conducted a stepped wedge cluster randomised controlled trial including 14 Belgian acute care hospitals with two medical and two surgical wards each. The intervention comprised a standardised observation and communication protocol including a pragmatic medical response strategy. Comorbidity and nurse staff levels were collected as potential confounders.
Twenty-eight wards of seven hospitals were studied from October 2013 until May 2015 and included in the final analysis. The control group contained 34,267 patient admissions and the intervention group 35,389. When adjusted for clustering and study time, we found no significant difference between the control and intervention group in unexpected death rates (1.5 vs 0.7/1000, OR 0.82, 95%CI 0.34-1.95), cardiac arrest rates (1.3 vs 1.0/1000, OR 0.71, 95%CI 0.33-1.52) or unplanned ICU admissions (6.5 vs 10.3/1000, OR 1.23, 95%CI 0.91-1.65).
Our intervention had no significant effect on the incidence of unexpected death, cardiac arrest or unplanned ICU admission when adjusted for clustering and study time. We found a lower than expected baseline incidence of unexpected death and cardiac arrest rates which reduced the statistical power significantly in this study.
住院患者的病情恶化常常被忽视、误解和处理不当。快速反应系统（RRS）被提议用来解决这个问题。本研究旨在调查 RRS 对意外死亡、心肺复苏（CPR）伴心脏骤停和非计划转入重症监护病房（ICU）的发生率的影响。
我们进行了一项阶梯式楔形集群随机对照试验，纳入了 14 家比利时急性护理医院，每个医院有两个内科病房和两个外科病房。干预措施包括一个标准化的观察和沟通协议，包括一个实用的医疗应对策略。共病和护士人员水平被作为潜在的混杂因素进行了收集。
2013 年 10 月至 2015 年 5 月，7 家医院的 28 个病房进行了研究并纳入最终分析。对照组包含 34267 例患者入院，干预组包含 35389 例患者入院。在调整聚类和研究时间后，我们发现对照组和干预组之间的意外死亡率（1.5 比 0.7/1000，OR 0.82，95%CI 0.34-1.95）、心脏骤停率（1.3 比 1.0/1000，OR 0.71，95%CI 0.33-1.52）或非计划 ICU 入院率（6.5 比 10.3/1000，OR 1.23，95%CI 0.91-1.65）均无显著差异。
在调整聚类和研究时间后，我们的干预措施对意外死亡、心脏骤停或非计划 ICU 入院的发生率没有显著影响。我们发现，意外死亡和心脏骤停的发生率低于预期，这大大降低了本研究的统计效力。
