Impact of an Intensivist-Led Multidisciplinary Extended Rapid Response Team on Hospital-Wide Cardiopulmonary Arrests and Mortality
Impact of an Intensivist-Led Multidisciplinary Extended Rapid Response Team on Hospital-Wide Cardiopulmonary Arrests and Mortality
复制标题
DOI：
10.1097/ccm.0b013e318271440b
复制
发表时间：
2013-02-01
影响因子：
8.8
通讯作者：
Arabi, Yaseen
中科院分区：
文献类型：
--
作者：
Al-Qahtani, Saad;Al-Dorzi, Hasan M.;Arabi, Yaseen
目标：快速反应小组的有效性仍然存在争议。然而，许多研究的快速反应小组不是重症监护医师领导的，除了最初的激活之外的参与有限，并且不提供 ICU 后的随访。本研究的目的是探讨实施重症监护医师领导的多学科扩展快速反应小组对全院心肺骤停和死亡率的影响。设计：这是一项快速反应小组实施前后的研究。地点：沙特阿拉伯的三级护理学术中心。患者：2 年前快速反应小组中总共有 98,391 名患者，3 年后快速反应小组实施中共有 157,804 名患者。干预：任何医疗保健提供者都根据预先定义的标准启动快速反应小组，并由四名重症医生领导的多学科快速反应小组进行响应，以提供必要的管理和处置。快速反应小组的职能得到扩展，以提供随访直至临床稳定。此外，快速反应小组提供了至少 48 小时的强制性 ICU 后随访。测量和主要结果：主要结果是心肺骤停和死亡率。快速反应小组实施后，非 ICU 心肺骤停从每 1,000 例住院患者中 1.4 例下降到 0.9 例（相对风险，0.68；95% 置信区间，0.53-0.86；p = 0.001），住院总死亡率从每 1,000 例住院患者 22.5 例下降到 20.2 例（相对风险，0.90；95% 置信度）区间，0.85-0.95；p < 0.0001）。对于需要入住 ICU 的患者，快速反应团队实施后，急性生理学和慢性健康评估 II 评分从 29.3 +/- 9.3 显着降低至 26.9 +/- 8.5 (p < 0.0001)，医院死亡率从 57.4% 降低至 48.7%（相对风险，0.85；95% 置信区间， 0.78-0.92；p < 0.0001)。病房转诊的不复苏指令从每 1,000 名住院患者中的 0.7 例增加到 1.7 例（相对风险，2.58；95% 置信区间，1.95-3.42；p < 0.0001），从病房入住 ICU 的患者从 30.5% 下降到 26.1%（相对风险，0.86；95% 置信度）区间，0.74-0.99；p = 0.03）。此外，每 100 名 ICU 存活出院者，ICU 再入院率从 18.6 下降至 14.3（相对风险，0.77；95% 置信区间，0.66-0.89；p < 0.0001），ICU 出院后死亡率从 18.2% 下降至 14.8%（相对风险，0.85；95% 置信区间， 0.72-0.99；p = 0.04）。结论：快速反应团队的实施有效减少了病房患者的心肺骤停和住院总死亡率，改善了需要入住 ICU 的患者的转归，并减少了 ICU 出院患者的再入院和死亡率。 （重症监护医学 2013 年；41：506-517）
Objective: The effectiveness of rapid response teams remains controversial. However, many studied rapid response teams were not intensivist-led, had limited involvement beyond the initial activations, and did not provide post-ICU follow-up. The objective of this study was to examine the impact of implementing an intensivist-led multidisciplinary extended rapid response team on hospital-wide cardiopulmonary arrests and mortality.Design: This was a pre-post rapid response team implementation study.Setting: Tertiary care academic center in Saudi Arabia.Patients: A total of 98,391 patients in the 2-yr pre-rapid response team and 157,804 patients in the 3-yr post-rapid response team implementation were evaluated.Intervention: The rapid response team was activated by any health care provider based on pre-defined criteria and a four-member intensivist-led multidisciplinary rapid response team responded to provide the necessary management and disposition. The rapid response team function was extended to provide follow-up until clinical stabilization. In addition, the rapid response team provided a mandatory post-ICU follow-up for a minimum of 48 hrs.Measurements and Main Results: The primary outcomes were cardiopulmonary arrests and mortality. After rapid response team implementation, non-ICU cardiopulmonary arrests decreased from 1.4 to 0.9 per 1,000 hospital admissions (relative risk, 0.68; 95% confidence interval, 0.53-0.86; p = 0.001) and total hospital mortality decreased from 22.5 to 20.2 per 1,000 hospital admissions (relative risk, 0.90; 95% confidence interval, 0.85-0.95; p < 0.0001). For patients who required admission to the ICU, there was a significant reduction in the Acute Physiology and Chronic Health Evaluation II scores after rapid response team implementation from 29.3 +/- 9.3 to 26.9 +/- 8.5 (p < 0.0001), with reduction in hospital mortality from 57.4% to 48.7% (relative risk, 0.85; 95% confidence interval, 0.78-0.92; p < 0.0001). Do-not-resuscitate orders for ward referrals increased from 0.7 to 1.7 per 1,000 hospital admissions (relative risk, 2.58; 95% confidence interval, 1.95-3.42; p < 0.0001) and decreased for patients admitted to ICU from the wards from 30.5% to 26.1% (relative risk, 0.86; 95% confidence interval, 0.74-0.99; p = 0.03). Additionally, ICU readmission rate decreased from 18.6 to 14.3 per 100 ICU alive discharges (relative risk, 0.77; 95% confidence interval, 0.66-0.89; p < 0.0001) and post-ICU hospital mortality from 18.2% to 14.8% (relative risk, 0.85; 95% confidence interval, 0.72-0.99; p = 0.04).Conclusion: The implementation of rapid response team was effective in reducing cardiopulmonary arrests and total hospital mortality for ward patients, improving the outcomes of patients who needed ICU admission and reduced readmissions and mortality of patients who were discharged from the ICU. (Crit Care Med 2013;41:506-517)