"Identifying the hospitalised patient in crisis"-A consensus conference on the afferent limb of Rapid Response Systems

被引：270

作者：

DeVita, Michael A. ^{[2
]}

Smith, Gary B. ^{[1
,3
]}

Adam, Sheila K. ^{[4
]}

Adams-Pizarro, Inga ^{[5
]}

Buist, Michael ^{[6
]}

Bellomo, Rinaldo ^{[7
]}

Bonello, Robert ^{[8
,9
]}

Cerchiari, Erga ^{[10
]}

Farlow, Barbara ^{[11
]}

Goldsmith, Donna ^{[12
]}

Haskell, Helen ^{[13
]}

Hillman, Kenneth ^{[14
,15
]}

Howell, Michael ^{[16
,17
]}

Hravnak, Marilyn ^{[18
]}

Hunt, Elizabeth A. ^{[19
]}

Hvarfner, Andreas ^{[20
]}

Kellett, John ^{[21
]}

Lighthall, Geoffrey K. ^{[22
]}

Lippert, Anne ^{[23
]}

Lippert, Freddy K.

Mahroof, Razeen ^{[24
]}

Myers, Jennifer S. ^{[25
]}

Rosen, Mark ^{[26
,27
]}

Reynolds, Stuart ^{[28
]}

Rotondi, Armando ^{[29
,30
]}

Rubulotta, Francesca ^{[31
]}

Winters, Bradford ^{[19
]}

机构：

[1] Queen Alexandra Hosp, Portsmouth Hosp NHS Trust, Dept Crit Care, Portsmouth PO6 3LY, Hants, England

[2] W Penn Allegheny Hlth Syst, Pittsburgh, PA USA

[3] Bournemouth Univ, Bournemouth, Dorset, England

[4] Univ Coll London Hosp NHS Fdn Trust, London, England

[5] Maryland Patient Safety Ctr, Elkridge, MD USA

[6] Univ Tasmania, Rural Clin Sch, Hobart, Tas 7001, Australia

[7] Austin Hosp, Heidelberg, Vic 3084, Australia

[8] Univ Minnesota, Minneapolis, MN USA

[9] Minneapolis VA Med Ctr, Minneapolis, MN USA

[10] Maggiore Hosp, Bologna, Italy

[11] Patients Patient Safety Canada, Mississauga, ON, Canada

[12] Austin Hlth, Heidelberg, Vic, Australia

[13] Mothers Med Error, Columbia, SC USA

[14] Univ New S Wales, Liverpool, NSW, Australia

[15] Simpson Ctr Hlth Serv Res, Liverpool, NSW, Australia

[16] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA

[17] Harvard Univ, Sch Med, Boston, MA USA

[18] Univ Pittsburgh, Pittsburgh, PA USA

[19] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[20] Univ Hosp, Lund, Sweden

[21] Nenagh Hosp, Nenagh, Cty Tipperary, Ireland

[22] Stanford Univ, Sch Med, Stanford, CA 94305 USA

[23] Herlev Hosp, Danish Inst Med Simulat, DK-2730 Herlev, Denmark

[24] John Radcliffe Hosp, Oxford OX3 9DU, England

[25] Univ Penn, Philadelphia, PA 19104 USA

[26] N Shore Univ Hosp, New York, NY USA

[27] Long Isl Jewish Med Ctr, New York, NY USA

[28] Univ Toronto, Toronto, ON, Canada

[29] Univ Pittsburgh, Sch Med, Pittsburg, KS USA

[30] Dept Vet Affairs, Pittsburg, KS USA

[31] Univ London Imperial Coll Sci Technol & Med, St Marys Hosp, Dept Anaethesia, London, England

来源：

RESUSCITATION | 2010年 / 81卷 / 04期

基金：

美国医疗保健研究与质量局;

关键词：

Rapid response system; Monitoring; Vital signs; Medical emergency team; Rapid response team; Critical care outreach; Cardiac arrest; Resuscitation; Patient safety; Risk; MEDICAL EMERGENCY TEAM; EARLY WARNING SCORE; CLINICALLY ABNORMAL OBSERVATIONS; QUALITY-OF-CARE; INTENSIVE-CARE; CARDIAC ARRESTS; TRIGGER SYSTEMS; GENERAL WARDS; PERFORMANCE EVALUATION; RANDOMIZED EVALUATION;

D O I：

10.1016/j.resuscitation.2009.12.008

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: Most reports of Rapid Response Systems (RRS) focus on the efferent, response component of the system, although evidence suggests that improved vital sign monitoring and recognition of a clinical crisis may have outcome benefits. There is no consensus regarding how best to detect patient deterioration or a clear description of what constitutes patient monitoring. Methods: A consensus conference of international experts in safety, RRS, healthcare technology, education, and risk prediction was convened to review current knowledge and opinion on clinical monitoring. Using established consensus procedures, four topic areas were addressed: (1) To what extent do physiologic abnormalities predict risk for patient deterioration? (2) Do workload changes and their potential stresses on the healthcare environment increase patient risk in a predictable manner? (3) What are the characteristics of an "ideal" monitoring system, and to what extent does currently available technology meet this need? and (4) How can monitoring be categorized to facilitate comparing systems? The major findings include: (1) vital sign aberrations predict risk, (2) monitoring patients more effectively may improve outcome, although some risk is random, (3) the workload implications of monitoring on the clinical workforce have not been explored, but are amenable to study and should be investigated, (4) the characteristics of an ideal monitoring system are identifiable, and it is possible to categorize monitoring modalities. It may also be possible to describe monitoring levels, and a system is proposed. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

引用

页码：375 / 382

页数：8

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