Deakin University: School of Nursing and Midwifery & Centre for Quality and Patient Safety in the Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria 3220, Australia. Electronic address: https://twitter.com/@Steph_Sprogis.
Deakin University: School of Nursing and Midwifery & Centre for Quality and Patient Safety in the Institute for Health Transformation, 1 Gheringhap St, Geelong, Victoria 3220, Australia; Deakin University: Deakin Learning Futures, Office of the Deputy Vice Chancellor (Education), 1 Gheringhap St, Geelong, Victoria 3220, Australia. Electronic address: https://twitter.com/@Judy_Currey.
Intensive Crit Care Nurs. 2021 Aug;65:103041. doi: 10.1016/j.iccn.2021.103041. Epub 2021 Mar 30.
The aim of this review was to explore use of the pre-Medical Emergency Team (pre-MET) tier of Rapid Response Systems to recognise and respond to adult ward patients experiencing early clinical deterioration.
A scoping review of studies published in English reporting on use of a pre-MET tier in adult ward patients was conducted. Three databases were searched (Medline, CINAHL, EMBASE) for studies published between January 1995 and September 2020. Two researchers independently performed screening and quality assessments. Findings were synthesised thematically. Reporting of the review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.
Six of 1669 studies were included in this review. All were single-site studies of single-parameter Rapid Response Systems in Australian hospitals. Five were quantitative studies; one had a qualitative design. Studies fulfilled 50-100% of quality criteria. Two themes were constructed: Afferent processes - Recognising and escalating pre-MET events; and Efferent processes - Pre-MET reviews and associated interventions. There was disparity between clinical practice and pre-MET escalation protocols, and reports of nurse-initiated management of early deterioration. Prospective methods and exploration of multidisciplinary perspectives were notable research gaps.
Use of the pre-MET tier of Rapid Response Systems is under-researched. Further research is needed to understand barriers and facilitators influencing use of pre-MET strategies to address patient deterioration.
本综述旨在探讨使用医疗急救前团队（pre-MET）这一快速反应系统层级来识别和应对成人病房中出现早期临床恶化的患者。
对发表于英文文献中、报告使用成人病房中 pre-MET 层级的研究进行了范围综述。在 1995 年 1 月至 2020 年 9 月期间，在 Medline、CINAHL 和 EMBASE 三个数据库中检索了研究。两名研究人员独立进行了筛选和质量评估。结果以主题形式进行综合。该综述的报告遵循了系统评价和荟萃分析扩展的首选报告项目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews）。
在 1669 篇研究中，有 6 篇被纳入本综述。这些研究均来自澳大利亚医院的单参数快速反应系统的单站点研究。其中 5 项为定量研究，1 项为定性设计。研究满足 50%-100%的质量标准。构建了两个主题：传入过程 - 识别和升级 pre-MET 事件；传出过程 - pre-MET 审查和相关干预。临床实践与 pre-MET 升级协议之间以及护士对早期恶化进行管理的报告存在差异。值得注意的研究空白是前瞻性方法和多学科视角的探索。
对使用 pre-MET 层级的快速反应系统的研究不足。需要进一步研究，以了解影响使用 pre-MET 策略来处理患者恶化的障碍和促进因素。
