Department of Pediatrics, Section of Hospital Medicine, School of Medicine, University of Colorado, Aurora, Colorado;
School of Medicine, University of Colorado and Children's Hospital Colorado, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, Colorado.
Hosp Pediatr. 2021 Feb;11(2):144-152. doi: 10.1542/hpeds.2020-002659.
Many hospitals use rapid response systems (RRSs) to identify and intervene on hospitalized children at risk for deterioration.
To describe RRS characteristics across hospitals in the Pediatric Research in Inpatient Settings (PRIS) network.
We developed the survey through a series of prospective respondent, expert, and cognitive interviews. One institutional expert per PRIS hospital ( = 109) was asked to complete the web survey. We summarized responses using descriptive statistics with a secondary analysis of univariate associations between RRS characteristics and perceived effectiveness.
The response rate was 72% (79 of 109). Respondents represented diverse hospital types and were primarily physicians (97%) with leadership roles in care escalation. Many hospitals used an early warning score (77%) for identification with variable characteristics (46% automated versus 54% full or partially manual calculation; inputs included vital signs [98%], physical examination findings [88%], diagnoses [23%], medications [19%], and diagnostic tests [14%]). Few incorporated a validated prediction model (9%). Similarly, many RRSs used a rapid response team for intervention (93%) with variable team composition (respiratory therapists [94%], ICU nurses [93%], ICU providers [67%], and pharmacists [27%]). Some used the early warning score to trigger the rapid response team (50%). Only a few staffed a clinician to proactively surveil hospitalized children for risk of deterioration (18%), and these tended to be larger hospitals (annual admissions 12 000 vs 6000, = .007). Most responding experts stated their RRSs improved patient outcomes (92%).
RRS characteristics varied across PRIS hospitals.
许多医院使用快速反应系统（RRS）来识别和干预有恶化风险的住院儿童。
描述 PRIS 网络中各医院的 RRS 特征。
我们通过一系列前瞻性应答者、专家和认知访谈来开发该调查。要求 PRIS 医院的每位机构专家（n=109）完成网络调查。我们使用描述性统计对应答进行总结，并对 RRS 特征与感知效果之间的单变量关联进行二次分析。
应答率为 72%（79/109）。应答者代表了不同类型的医院，主要是医生（97%），在病情升级方面具有领导作用。许多医院使用早期预警评分（EWS）进行识别，其特征具有变异性（46%自动计算，54%全或部分手动计算；输入项包括生命体征[98%]、体格检查结果[88%]、诊断[23%]、药物[19%]和诊断性检查[14%]）。很少有医院采用验证过的预测模型（9%）。同样，许多 RRS 使用快速反应团队进行干预（93%），团队组成具有变异性（呼吸治疗师[94%]、ICU 护士[93%]、ICU 医生[67%]和药剂师[27%]）。一些医院使用 EWS 来触发快速反应团队（50%）。只有少数医院配备了临床医生来主动监测住院儿童的恶化风险（18%），这些医院往往规模较大（年住院人次 12000 与 6000，P=.007）。大多数应答专家表示，他们的 RRS 改善了患者结局（92%）。
PRIS 医院的 RRS 特征存在差异。
