O'Connell Alice, Flabouris Arthas, Edwards Suzanne, Thompson Campbell H
Consultant, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Crit Care Resusc. 2023 May 20;25(1):47-52. doi: 10.1016/j.ccrj.2023.04.010. eCollection 2023 Mar.
Many rapid response systems now have multiple tiers of escalation in addition to the traditional single tier of a medical emergency team. Given that the benefit to patient outcomes of this change is unclear, we sought to investigate the workload implications of a multitiered system, including the impact of trigger modification.
The study design incorporated a post hoc analysis using a matched case-control dataset.
The study setting was an acute, adult tertiary referral hospital.
Cases that had an adverse event (cardiac arrest or unanticipated intensive care unit admission) or a rapid response team (RRT) call participated in the study. Controls were matched by age, gender, ward and time of year, and no adverse event or RRT call. Participants were admitted between May 2014 and April 2015.
The main outcome measure were the number of reviews, triggers, and modifications across three tiers of escalation; a nurse review, a multidisciplinary review (MDT-admitting medical team review), and an RRT call.
There were 321 cases and 321 controls. Overall, there were 1948 nurse triggers, of which 1431 (73.5%) were in cases and 517 (26.5%) in controls, 798 MDT triggers (660 [82.7%] in cases and 138 [17.3%] in controls), and 379 RRT triggers (351 [92.6%] in cases and 28 [7.4%] in controls). Per patient per 24 h, there were 3.03 nurse, 1.24 MDT, and 0.59 RRT triggers. Accounting for modifications, this reduced to 2.17, 0.88, and 0.42, respectively. The proportion of triggers that were modified, so as not to trigger a review, was similar across all the tiers, being 28.6% of nurse, 29.6% of MDT, and 28.2% of RRT triggers. Per patient per 24 h, there were 0.61 nurse reviews, 0.52 MDT reviews, and 0.08 RRT reviews.
Lower-tier triggers were more prevalent, and modifications were common. Modifications significantly mitigated the escalation workload across all tiers of a multitiered system.
现在许多快速反应系统除了传统的单一层级医疗急救团队外，还有多个升级层级。鉴于这种变化对患者预后的益处尚不清楚，我们试图研究多层级系统对工作量的影响，包括触发因素修改的影响。
本研究设计采用了基于匹配病例对照数据集的事后分析。
研究设置为一家急性成人三级转诊医院。
发生不良事件（心脏骤停或意外入住重症监护病房）或呼叫快速反应团队（RRT）的病例参与了研究。对照组按年龄、性别、病房和年份时间进行匹配，且无不良事件或RRT呼叫。参与者于2014年5月至2015年4月期间入院。
主要结局指标为三个升级层级的审查、触发因素和修改的数量；护士审查、多学科审查（MDT - 收治医疗团队审查）和RRT呼叫。
有321例病例和321例对照。总体而言，有1948次护士触发，其中1431次（73.5%）发生在病例组，517次（26.5%）发生在对照组；798次MDT触发（660次[82.7%]在病例组，138次[17.3%]在对照组）；379次RRT触发（351次[92.6%]在病例组，28次[7.4%]在对照组）。每24小时每例患者，有3.03次护士触发、1.24次MDT触发和0.59次RRT触发。考虑到修改因素，这分别降至2.17次、0.88次和0.42次。在所有层级中，为避免触发审查而修改的触发因素比例相似，护士触发因素中为28.6%，MDT触发因素中为29.6%，RRT触发因素中为28.2%。每24小时每例患者，有0.61次护士审查、0.52次MDT审查和0.08次RRT审查。
较低层级的触发因素更为普遍，且修改很常见。修改显著减轻了多层级系统所有层级的升级工作量。
