School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
Centre for Quality and Patient Safety Research, Deakin University, Geelong, Victoria, Australia.
Scand J Trauma Resusc Emerg Med. 2021 May 22;29(1):69. doi: 10.1186/s13049-021-00882-6.
Assessing and managing the risk of clinical deterioration is a cornerstone of emergency care, commencing at triage and continuing throughout the emergency department (ED) care. The aim of this scoping review was to assess the extent, range and nature of published research related to formal systems for recognising and responding to clinical deterioration in emergency department (ED) patients.
We conducted a scoping review according to PRISMA-ScR guidelines. MEDLINE complete, CINAHL and Embase were searched on 07 April 2021 from their dates of inception. Human studies evaluating formal systems for recognising and responding to clinical deterioration occurring after triage that were published in English were included. Formal systems for recognising and responding to clinical deterioration were defined as: i) predefined patient assessment criteria for clinical deterioration (single trigger or aggregate score), and, or ii) a predefined, expected response should a patient fulfil the criteria for clinical deterioration. Studies of short stay units and observation wards; deterioration during the triage process; system or score development or validation; and systems requiring pathology test results were excluded. The following characteristics of each study were extracted: author(s), year, design, country, aims, population, system tested, outcomes examined, and major findings.
After removal of duplicates, there were 2696 publications. Of these 33 studies representing 109,066 patients were included: all were observational studies. Twenty-two aggregate scoring systems were evaluated in 29 studies and three single trigger systems were evaluated in four studies. There were three major findings: i) few studies reported the use of systems for recognising and responding to clinical deterioration to improve care of patients whilst in the ED; ii) the systems for recognising clinical deterioration in ED patients were highly variable and iii) few studies reported on the ED response to patients identified as deteriorating.
There is a need to re-focus the research related to use of systems for recognition and response to deteriorating patients from predicting various post-ED events to their real-time use to improve patient safety during ED care.
评估和管理临床恶化风险是急诊护理的基石，从分诊开始，并贯穿整个急诊部门（ED）护理。本范围综述的目的是评估与识别和应对急诊患者临床恶化相关的已发表研究的程度、范围和性质。
我们根据 PRISMA-ScR 指南进行了范围综述。2021 年 4 月 7 日，从其成立日期起，在 MEDLINE 完整、CINAHL 和 Embase 上进行了搜索。纳入评估在分诊后发生的临床恶化的识别和应对的正式系统的人类研究，这些研究以英语发表。识别和应对临床恶化的正式系统定义为：i）用于临床恶化的患者评估标准的预设（单一触发或综合评分），和/或 ii）如果患者符合临床恶化的标准，应预设的预期反应。排除短期留观病房和观察病房的研究；分诊过程中的恶化；系统或评分的开发或验证；以及需要病理检查结果的系统。提取了每个研究的以下特征：作者、年份、设计、国家、目的、人群、测试的系统、检查的结果以及主要发现。
去除重复项后，有 2696 篇出版物。其中 33 项研究代表 109066 名患者，均为观察性研究。29 项研究评估了 22 个综合评分系统，4 项研究评估了 3 个单一触发系统。有三个主要发现：i）很少有研究报告使用系统来识别和应对临床恶化以改善患者在 ED 中的护理；ii）ED 患者识别临床恶化的系统差异很大；iii）很少有研究报告 ED 对识别为恶化的患者的反应。
有必要重新关注与识别和应对恶化患者的系统相关的研究，从预测 ED 后的各种事件转移到实时使用这些系统来提高 ED 护理期间的患者安全性。
