Fujiwara Shinsuke, Atagi Kazuaki, Moriyasu Megumi, Naito Takaki, Taneda Kenichiro, Hsu Hsiang-Chin, Lefor Alan Kawarai, Fujitani Shigeki
Department of Emergency NHO Ureshino Medical Center Ureshino Japan.
Department of Intensive Care Unit Nara Prefecture General Medical Center Nara Japan.
Acute Med Surg. 2020 Feb 11;7(1):e488. doi: 10.1002/ams2.488. eCollection 2020 Jan-Dec.
In Japan, the number of facilities introducing a rapid response system (RRS) has been increasing. However, many institutions have had unsuccessful implementations. In order to implement RRS smoothly, a plan that meets the needs of each hospital is needed.
Rapid response system teams from each hospital, including a physician and staff in charge of medical safety, from the RRS online registry were invited to attend a workshop. The workshop aimed to develop and implement RRS. The course curriculum was based on the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) developed in the USA. Participating facilities were required to formulate an RRS introduction plan referring to Kotter's 8-step change model to overcome barriers in the implementation of RRS. The change in medical emergency team activations comparing the intervention and control group hospitals was compared.
Sixteen institutions were eligible for this study. After participating in the workshop, there was a tendency toward more frequent activation of medical emergency teams in the intervention group ( = 0.075). According to a self-evaluation from each facility, there is great difficulty in overcoming the 5th step of Kotter's model (empower people to act the vision).
This step-by-step evaluation clearly identified a problem with implementation and provided measures for resolution corresponding to each facility. There was a major barrier to overcome the 5th step of Kotter's model in leading change, which represents the attitude toward implementing RRS in institutions.
在日本，引入快速反应系统（RRS）的医疗机构数量一直在增加。然而，许多机构的实施并不成功。为了顺利实施RRS，需要一个满足每家医院需求的计划。
邀请来自RRS在线登记处的每家医院的快速反应系统团队，包括一名医生和负责医疗安全的工作人员，参加一个研讨会。该研讨会旨在开发和实施RRS。课程设置基于美国开发的团队策略与工具以提升绩效和患者安全（TeamSTEPPS）。要求参与的机构参考科特的八步变革模型制定RRS引入计划，以克服RRS实施中的障碍。比较了干预组和对照组医院医疗急救团队启动情况的变化。
16家机构符合本研究条件。参加研讨会后，干预组医疗急救团队的启动有更频繁的趋势（P = 0.075）。根据各机构的自我评估，在克服科特模型的第5步（授权人们按照愿景行动）方面存在很大困难。
这种逐步评估清楚地确定了实施中的问题，并为每个机构提供了相应的解决措施。在引领变革方面，克服科特模型的第5步存在重大障碍，这代表了机构对实施RRS的态度。
