Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Department of Nursing and Clinical Care Services, Children's Hospital of Philadelphia, Philadelphia, PA.
Pediatr Crit Care Med. 2020 May;21(5):e221-e227. doi: 10.1097/PCC.0000000000002256.
To evaluate the effect of providing early attending physician involvement via telemedicine to improve the decision process of rapid response teams.
Quasi-experimental; three pairs of control/intervention months: June/July; August/October; November/December.
Single-center, urban, quaternary academic children's hospital with three-member rapid response team: critical care fellow or nurse practitioner, nurse, respiratory therapist. Baseline practice: rapid response team leader reviewed each evaluation with an ICU attending physician within 2 hours after return to ICU.
Implementation of a smartphone-based telemedicine platform to facilitate early co-assessment and disposition planning between the rapid response team at the patient's bedside and the attending in the ICU.
As a marker of efficiency, the primary provider outcome was time the rapid response team spent per patient encounter outside the ICU prior to disposition determination. The primary patient outcome was percentage of patients requiring intubation or vasopressors within 60 minutes of ICU transfer. There were three pairs of intervention/removal months. In the first 2 pairs, the intervention was associated with the rapid response team spending less time on rapid response team calls (June/July: point estimate -5.24 min per call; p < 0.01; August/October: point estimate -3.34 min per call; p < 0.01). During the first of the three pairs, patients were significantly less likely to require intubation or vasopressors within 60 minutes of ICU transfer (adjusted odds ratio, 0.66; 95 CI, 0.51-0.84; p < 0.01).
Early in the study, more rapid ICU attending involvement via telemedicine was associated with rapid response team providers spending less time outside the ICU, and among patients transferred to the ICU, a significant decrease in likelihood of patients requiring vasopressors or intubation within the first 60 minutes of transfer. These findings provide evidence that early ICU attending involvement via telemedicine can improve efficiency of rapid response team evaluations.
评估通过远程医疗提供早期主治医生参与以改善快速反应团队决策过程的效果。
准实验；三组对照/干预月份：6 月/7 月；8 月/10 月；11 月/12 月。
单中心，城市，四级学术儿童医院，有三名成员的快速反应团队：重症监护医生或护士从业者，护士，呼吸治疗师。基线实践：快速反应团队负责人在返回 ICU 后 2 小时内与 ICU 主治医生一起审查每次评估。
1）快速反应团队评估的患者，2）快速反应团队成员。
实施基于智能手机的远程医疗平台，以促进快速反应团队在患者床边与 ICU 主治医生之间进行早期共同评估和处置计划。
作为效率的标志，主要的医疗提供者结果是快速反应团队在做出处置决定之前，在 ICU 外对每位患者的诊治时间。主要的患者结果是在 ICU 转移后 60 分钟内需要插管或血管加压素的患者比例。有三组干预/去除月份。在前两组中，干预措施与快速反应团队在快速反应团队电话上花费的时间减少有关（6 月/7 月：点估计-5.24 分钟/次；p<0.01；8 月/10 月：点估计-3.34 分钟/次；p<0.01）。在三组中的第一组中，在 ICU 转移后 60 分钟内需要插管或血管加压素的患者显著减少（调整后的优势比，0.66；95%置信区间，0.51-0.84；p<0.01）。
在研究早期，通过远程医疗进行更多的早期 ICU 主治医生参与与快速反应团队提供者在 ICU 外花费的时间减少有关，并且在转移到 ICU 的患者中，在转移后的头 60 分钟内需要血管加压素或插管的患者的可能性显著降低。这些发现提供了证据表明，通过远程医疗进行早期 ICU 主治医生参与可以提高快速反应团队评估的效率。
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