Noguchi Ayako, Yokota Isao, Kimura Tetsuya, Yamasaki Masaki
Department of Nursing, University Hospital, Kyoto Prefectural University of Medicine (KPUM), 465 Kajii-cho, Kawaramachi Hirokouji-agaru Kamigyo-ku, 602-8566, Kyoto, Japan.
Department of Disaster and Critical Care Nursing, Track of Nursing Innovation Science, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima Bunkyo-ku, Tokyo, 113-8510, Japan.
Heliyon. 2023 Jun 15;9(6):e17155. doi: 10.1016/j.heliyon.2023.e17155. eCollection 2023 Jun.
In this study, we investigated the impact of critical care outreach implemented to overcome the problem of rapid response system (RRS) activation. The aim was to evaluate the impact of nurse-led proactive rounding on the rate of adverse events in a hospital setting using an automatic early-warning score system, without a call-activated team.
This observational study was conducted at a university hospital in Japan. Beginning in September 2019, critical care outreach via nurse-led proactive rounding of the general ward was conducted, using an automatic early-warning score system. We retrospectively assessed the computerised records of all inpatient days (N = 497,284) of adult inpatients admitted to the hospital from September 2017 to 2020. We compared the adverse event occurrences before and after implementation of the critical care outreach program. The main outcome measures were: unexpected death in the general ward, code blue (an in-hospital resuscitation request code directed towards all staff via broadcast) for non-intensive care unit inpatients and unexpected intensive care unit admissions from the general ward. The secondary outcome was the proportion of patients who received respiratory rate measurement.
The incidence rate ratios of the occurrence of unexpected deaths (0.19, 95% confidence interval: 0.04-0.57) and code blue in the general ward (0.15, 95% confidence interval: 0.025-0.50) decreased. There was no change in unexpected intensive care unit admissions from the general ward (1.25, confidence interval: 0.84-1.82). The proportion of patients who received respiratory rate measurement increased (10.2% vs 16.2%).
Our results suggest that in RRSs, drastic control of the failure of the mechanism to activate a response team may produce positive outcomes. Proactive rounding that bypasses the mechanism to activate a response team component of RRSs may relieve ward nurses of activation failure responsibility and help them overcome the hierarchical hospital structure.
在本研究中，我们调查了实施重症监护外展服务以克服快速反应系统（RRS）激活问题的影响。目的是使用自动早期预警评分系统，在没有呼叫激活团队的情况下，评估护士主导的主动查房对医院环境中不良事件发生率的影响。
这项观察性研究在日本的一家大学医院进行。从2019年9月开始，通过护士主导的对普通病房的主动查房开展重症监护外展服务，使用自动早期预警评分系统。我们回顾性评估了2017年9月至2020年期间入住该医院的成年住院患者的所有住院天数的计算机记录（N = 497,284）。我们比较了重症监护外展计划实施前后不良事件的发生情况。主要结局指标为：普通病房意外死亡、非重症监护病房住院患者的蓝色急救代码（通过广播向所有工作人员发出的院内复苏请求代码）以及普通病房意外入住重症监护病房。次要结局是接受呼吸频率测量的患者比例。
普通病房意外死亡（发生率比为0.19，95%置信区间：0.04 - 0.57）和蓝色急救代码（发生率比为0.15，95%置信区间：0.025 - 0.50）的发生率比有所下降。普通病房意外入住重症监护病房的情况没有变化（发生率比为1.25，置信区间：0.84 - 1.82）。接受呼吸频率测量的患者比例有所增加（10.2%对16.2%）。
我们的结果表明，在快速反应系统中，对激活反应团队机制失败的严格控制可能会产生积极结果。绕过快速反应系统中激活反应团队组成部分机制的主动查房可能会减轻病房护士对激活失败的责任，并帮助他们克服医院的层级结构。
