背景:ICU外住院患者的临床恶化是潜在的可逆发病率和死亡率的来源。为了解决这个问题,一些急性护理机构已经实施了旨在检测和应对此类患者的系统。
目的:为医院临床医生和管理者提供循证建议,以优化对非ICU患者临床恶化的认识和反应。
■由25名成员组成的小组包括来自医学的代表,护理,呼吸治疗,药房,患者/家庭伴侣,以及在制定循证临床实践指南方面具有专业知识的临床医生方法学家。
方法:我们使用人口生成了可操作的问题,干预,Control,和结果格式,并对文献进行了系统的审查,以确定和综合最佳的可用证据。我们使用了建议评级评估,发展,和评估方法,以确定证据的确定性并制定建议和良好做法声明(GPS)。
结果:专家组发表了10项关于识别和应对非ICU危重病患者的声明。医疗保健人员和机构应确保所有生命体征采集及时准确(GPS)。由于缺乏有关假阳性警报的益处和潜在危害的数据,我们不建议在“未选择”患者中使用连续生命体征监测。警报疲劳的风险,和成本。我们建议对床旁临床医生进行临床恶化迹象的重点教育,我们还建议将患者/家属/护理伙伴的担忧纳入获取额外意见和帮助的决策中(均为有条件的建议).我们建议在医院范围内部署具有明确激活标准的快速反应小组或医疗急救小组(RRT/MET)(强烈推荐)。我们不建议RRT/MET专业组成或将姑息治疗成员纳入应对团队,但建议应对者的技能应包括激发患者的护理目标(有条件推荐)。最后,质量改进过程应该是快速反应系统(GPS)的一部分。
结论:专家组提供了指导,告知临床医生和管理者如何有效地改善ICU以外危重患者的护理。
Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.
To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.
The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice
guidelines.
We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).
The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among \"unselected\" patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners\' concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients\' goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS).
The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.