Incorporating an Early Detection System Into Routine Clinical Practice in Two Community Hospitals
Incorporating an Early Detection System Into Routine Clinical Practice in Two Community Hospitals
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DOI：
10.1002/jhm.2661
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发表时间：
2016-11-01
影响因子：
2.6
通讯作者：
Escobar, Gabriel J.
中科院分区：
文献类型：
--
作者：
Dummett, B. Alex;Adams, Carmen;Escobar, Gabriel J.
改善重症监护病房外病情恶化的患者预后的努力包括使用快速反应小组（RRT）以及手动和自动预后评分。尽管自动化早期预警系统 (EWS) 已开始进入临床实践，但很少有报告描述实施情况以及将早期预警方法集成到医院医生工作流程中所需的流程。我们描述了 2 家社区医院部署 EWS 的实施过程。我们采用了医疗保健改善研究所的迭代计划-实施-研究-行动方法。我们的基本工作流程依赖于 RRT 护士和 EWS 的 12 小时结果时间范围，已被临床医生接受，并且未与患者投诉相关。虽然我们的主要目标是开发一套将电子病历 EWS 集成到临床实践中的工作流程，但我们也发现了在将此干预措施传播到其他医院之前必须解决的问题。一个有问题的领域是警报后的文档记录。在传播干预措施之前必须解决的其他领域包括需要对临床医生进行有关部署 EWS 的基本原理的教育、仔细考虑部门间服务协议、临床医生职责的明确定义、务实的文档标准以及如何与患者沟通。除了将 EWS 部署到其他医院外，我们团队未来的方向将是描述临床反应本身的过程与结果关系。
Efforts to improve outcomes of patients who deteriorate outside the intensive care unit have included the use of rapid response teams (RRTs) as well as manual and automated prognostic scores. Although automated early warning systems (EWSs) are starting to enter clinical practice, there are few reports describing implementation and the processes required to integrate early warning approaches into hospitalists' workflows. We describe the implementation process at 2 community hospitals that deployed an EWS. We employed the Institute for Healthcare Improvement's iterative Plan-Do-Study-Act approach. Our basic workflow, which relies on having an RRT nurse and the EWS's 12-hour outcome time frame, has been accepted by clinicians and has not been associated with patient complaints. Whereas our main objective was to develop a set of workflows for integrating the electronic medical record EWS into clinical practice, we also uncovered issues that must be addressed prior to disseminating this intervention to other hospitals. One problematic area is that of documentation following an alert. Other areas that must be addressed prior to disseminating the intervention include the need for educating clinicians on the rationale for deploying the EWS, careful consideration of interdepartment service agreements, clear definition of clinician responsibilities, pragmatic documentation standards, and how to communicate with patients. In addition to the deployment of the EWS to other hospitals, a future direction for our teams will be to characterize process-outcomes relationships in the clinical response itself.