Gupta Rohit R, Gonzalez Cristhian, Wang Jennifer, Martillo Miguel, Kohli-Seth Roopa
Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Postgrad Med J. 2021 Jul;97(1149):459-463. doi: 10.1136/postgradmedj-2020-137497. Epub 2021 Jan 13.
Decompensating patients require expeditious and focused care at the bedside. This can be particularly challenging when there are multiple layers of providers, each with differing specialisation, experience and autonomy. We examined the impact of our intensivist-driven hospital-wide rapid response team (RRT) at our 1171-bed quaternary care centre.
Single-centre retrospective cohort study.
RRT service was implemented to assess, manage and triage acutely ill patients outside the intensive care unit (ICU). Criteria for consultation and workflow were established. The 24/7 team was led by an intensivist and included nurse practitioners and respiratory therapists. Over 3 years, we reviewed the impact of the RRT on patient outcomes and critical care support beyond the ICU.
Over 3 years, the RRT received 31 392 consults for 12 122 individual patients averaging 30 consults over 24 hours. 58.9% of the calls received were for sepsis alerts/risk of decompensation and 41.1% of the consults were for reasons of acute decompensation. Among patients that were seen by the RRT, over the course of their hospital stay, 14% were upgraded to a step-down unit, 18% were upgraded to the ICU and 68% completed care without requiring any escalation. The average mortality rate for patients seen by the RRT service during their hospital stay was 11.3% with an average 30-day readmission rate of 16.5% and average hospital length of stay 16 days without significant variation between the 3 years.
Intensivist-led RRT ensured consistent high value care. Early intervention and consistent supervision enabled timely and efficient delivery of critical care services.
失代偿患者需要在床边得到迅速且有针对性的治疗。当存在多层医疗服务提供者，且每个人的专业领域、经验和自主权都不同时，这可能会特别具有挑战性。我们在拥有1171张床位的四级医疗中心研究了由重症医学专家主导的全院快速反应团队（RRT）的影响。
单中心回顾性队列研究。
实施RRT服务以评估、管理和分诊重症监护病房（ICU）以外的急性病患者。建立了会诊标准和工作流程。这个全天候团队由一名重症医学专家领导，成员包括执业护士和呼吸治疗师。在3年多的时间里，我们回顾了RRT对患者预后以及ICU以外的重症监护支持的影响。
在3年多的时间里，RRT共收到针对12122名个体患者的31392次会诊请求，平均每天24小时有30次会诊。接到的呼叫中有58.9%是关于脓毒症警报/失代偿风险，41.1%的会诊是由于急性失代偿。在RRT会诊的患者中，在住院期间，14%被升级到过渡病房，18%被升级到ICU，68%在无需任何升级的情况下完成治疗。RRT服务的患者在住院期间的平均死亡率为11.3%，平均30天再入院率为16.5%，平均住院时间为16天，3年期间无显著差异。
由重症医学专家领导的RRT确保了持续的高价值治疗。早期干预和持续监督能够及时、高效地提供重症监护服务。
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