In search of the optimal rapid response system bundle.
In search of the optimal rapid response system bundle.
复制标题
寻找最佳的快速响应系统包。
DOI：
10.1002/jhm.2346
复制
发表时间：
2015
影响因子：
2.6
通讯作者：
Edelson,DanaP
中科院分区：
文献类型：
--
作者：
Churpek,MatthewM;Edelson,DanaP
The theory behind Rapid Response Teams (RRTs), namely to provide critical care resources to patients with clinical deterioration on the wards, is such common sense that failure to do so seems unethical. This idea, combined with evidence that many cardiac arrests on the wards are predictable and potentially preventable events, led to the proliferation of RRTs across the country and a Joint Commission mandate. 1 However, data from clinical trials have failed to consistently confirm the value of these teams, likely a product of the wide variability in implementation practices across institutions. 2In this edition of the Journal, Davis and colleagues demonstrate improvements in both mortality and cardiac arrest rates outside the ICU following implementation of their rapid response system in two hospitals. 3 While several other studies have shown similar results, what makes this implementation unique is the bundle approach that included proactive rounding by the charge nurse from each unit, annual focused training of team members and staff, and an integrated continuous quality improvement feedback loop. Bundles are common in successful quality improvement work but can be challenging for deciphering which of the individual components are driving the results, leaving readers to venture an educated guess. In the current bundle, the novel use of the charge nurse has some significant appeal as a candidate primary driver of the impact because it likely had two distinct actions:(1) proactive rounding, and (2) promoting a culture change, both of which are well supported in the literature. 4, 5
