Continuing Education and Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
School of Medicine, University of Crete, Heraklion, Greece.
Nurs Crit Care. 2024 Nov;29(6):1643-1653. doi: 10.1111/nicc.13096. Epub 2024 Jun 12.
Internationally, there is an increasing trend in using Rapid Response Systems (RRS) to stabilize in-patient deterioration. Despite a growing evidence base, there remains limited understanding of the processes in place to aid the early recognition and response to deteriorating children in hospitals across Europe.
To describe the processes in place for early recognition and response to in-patient deterioration in children in European hospitals.
A cross-sectional opportunistic multi-centre European study, of hospitals with paediatric in-patients, using a descriptive self-reported, web-based survey, was conducted between September 2021 and March 2022. The sampling method used chain referral through members of European and national societies, led by country leads. The survey instrument was an adaptation to the survey of Recognition and Response Systems in Australia. The study received ethics approval. Descriptive analysis and Chi-squared tests were performed to compare results in European regions.
A total of 185 questionnaires from 21 European countries were received. The majority of respondents (n = 153, 83%) reported having written policies, protocols, or guidelines, regarding the measurement of physiological observations. Over half (n = 120, 65%) reported that their hospital uses a Paediatric Early Warning System (PEWS) and 75 (41%) reported having a Rapid Response Team (RRT). Approximately one-third (38%) reported that their hospital collects specific data about the effectiveness of their RRS, while 100 (54%) reported providing regular training and education to support it. European regional differences existed in PEWS utilization (North = 98%, Centre = 25%, South = 44%, p < .001) and process evaluation (North = 49%, Centre = 6%, South = 36%, p < .001).
RRS practices in European hospitals are heterogeneous. Differences in the uptake of PEWS and RRS process evaluation emerged across Europe.
It is important to scope practices for the safe monitoring and management of deteriorating children in hospital across Europe. To reduce variance in practice, a consensus statement endorsed by paediatric and intensive care societies could provide guidance and resources to support PEWS implementation and for the operational governance required for continuous quality improvement.
在国际上，使用快速反应系统（RRS）来稳定住院患者恶化的趋势日益增加。尽管证据基础不断扩大，但对于如何帮助欧洲各地医院早期识别和应对病情恶化的儿童，仍缺乏了解。
描述欧洲医院中儿童住院患者早期识别和反应的过程。
这是一项在欧洲医院进行的横断面机会性多中心欧洲研究，涉及儿科住院患者，使用描述性自我报告的基于网络的调查，于 2021 年 9 月至 2022 年 3 月期间进行。采用通过欧洲和国家协会成员进行连锁推荐的抽样方法，由国家负责人领导。调查工具是对澳大利亚识别和反应系统调查的改编。该研究获得了伦理批准。进行了描述性分析和卡方检验，以比较欧洲各地区的结果。
共收到来自 21 个欧洲国家的 185 份问卷。大多数受访者（n=153，83%）报告说，他们有关于测量生理观察的书面政策、协议或指南。超过一半（n=120，65%）报告说他们的医院使用儿科预警系统（PEWS），75 人（41%）报告说他们有快速反应小组（RRT）。大约三分之一（38%）报告说他们的医院收集有关其 RRS 效果的数据，而 100 人（54%）报告说他们定期提供培训和教育以支持该系统。在 PEWS 的使用（北部=98%，中部=25%，南部=44%，p<.001）和流程评估（北部=49%，中部=6%，南部=36%，p<.001）方面，欧洲各地区存在差异。
欧洲医院的 RRS 实践存在异质性。欧洲各地在 PEWS 的采用和 RRS 流程评估方面存在差异。
了解欧洲医院中儿童安全监测和管理恶化的实践情况非常重要。为了减少实践中的差异，由儿科和重症监护协会认可的共识声明可以为 PEWS 的实施提供指导和资源，并为持续质量改进提供运营治理所需的资源。
