■除了传统的单层医疗急救小组之外,许多快速反应系统现在都有多层升级。鉴于这种变化对患者预后的益处尚不清楚,我们试图调查多层系统的工作量影响,包括触发器修改的影响。
■研究设计结合了使用匹配的病例对照数据集的事后分析。
■研究背景是急性的,成人三级转诊医院。
■有不良事件(心脏骤停或意外重症监护病房入院)或快速反应小组(RRT)呼叫的病例参与了研究。对照组按年龄匹配,性别,病房和一年中的时间,无不良事件或RRT调用。参与者在2014年5月至2015年4月期间被录取。
■主要结果指标是评论的数量,触发器,和跨三层升级的修改;护士审查,多学科审查(MDT-admittingmedicalteamreview),和RRT电话。
■有321例病例和321例对照。总的来说,有1948年的护士触发器,其中1431例(73.5%)为病例,517例(26.5%)为对照,798个MDT触发(病例为660个[82.7%],对照组为138个[17.3%]),和379个RRT触发因素(病例为351个[92.6%],对照组为28个[7.4%])。每位患者每24小时,有3.03护士,1.24MDT,和0.59RRT触发器。修改会计,分别降至2.17、0.88和0.42。被修改的触发器的比例,以免引发审查,在所有层面上都是相似的,占护士的28.6%,MDT的29.6%,和28.2%的RRT触发器。每位患者每24小时,有0.61条护士评论,0.52MDT评论,和0.08RRT评论。
■低层触发器更为普遍,和修改是常见的。修改大大减轻了多层系统所有层的升级工作负载。
UNASSIGNED: 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.
UNASSIGNED: The study design incorporated a post hoc analysis using a matched case-control dataset.
UNASSIGNED: The study setting was an acute, adult tertiary referral hospital.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: Lower-tier triggers were more prevalent, and modifications were common. Modifications significantly mitigated the escalation workload across all tiers of a multitiered system.