University of Texas at Austin, School of Nursing, 1710 Red River St., Mail Code D0100, Austin, TX 78701, United States.
University of Central Florida, College of Nursing, Orlando, FL, United States.
Int J Nurs Stud. 2019 Mar;91:128-133. doi: 10.1016/j.ijnurstu.2019.01.004. Epub 2019 Jan 12.
Unplanned escalations manifest as a breakdown of hospital care attributable to clinician error through missed or delayed identification of physiological instability, ineffective treatment, or iatrogenic harm.
To examine the impact of an Early Warning Score-based proactive rapid response team model on the frequency of unplanned intra-hospital escalations in care compared with a rapid response team model based on staff nurse identification of vital sign derangements.
Pre- and post Early Warning Score-guided proactive rapid response team model intervention.
237-bed community hospital in the southeastern United States.
All hospitalized adults (n = 12,148) during a pre- and post-intervention period.
Logistic regressions used to examine the relationship between unplanned ICU transfers and rapid response team models (rapid response team vs. Early Warning Score-guided proactive rapid response team).
Unplanned ICU transfers were 1.4 times more likely to occur during the rapid response team baseline period (OR = 1.392, 95% CI [1.017-1.905]) compared with the Early Warning Score-guided proactive rapid response team intervention period.
This study reports a difference in the frequency of unplanned escalations using different rapid response models, with fewer unplanned ICU transfers occurring during the use of Early Warning Score-guided proactive rapid response team model while accounting for differences in admission volumes, age, gender and comorbidities. Implementation of this model has implications for patient outcomes, hospital operations and costs.
计划外升级表现为由于临床医生未能及时识别生理不稳定、治疗无效或医源性伤害而导致的医院护理崩溃。
研究基于早期预警评分的主动快速反应团队模式与基于护士识别生命体征异常的快速反应团队模式相比，对护理中计划外院内升级频率的影响。
在早期预警评分指导下的主动快速反应团队模型干预的前后。
美国东南部的一家 237 张床位的社区医院。
干预前后所有住院成年人（n=12148）。
使用逻辑回归来检查计划外 ICU 转科与快速反应团队模型（快速反应团队与早期预警评分指导的主动快速反应团队）之间的关系。
与早期预警评分指导的主动快速反应团队干预期相比，快速反应团队基线期计划外 ICU 转科的可能性高 1.4 倍（OR=1.392，95%CI[1.017-1.905]）。
本研究报告了使用不同快速反应模型时计划外升级频率的差异，在使用早期预警评分指导的主动快速反应团队模型时，计划外 ICU 转科的次数减少，同时考虑了入院量、年龄、性别和合并症的差异。该模型的实施对患者结局、医院运营和成本都有影响。
