An Evaluation of the Effectiveness and Process of a Rapid Response System

描述（由申请人提供）：医疗保健改善研究所（IHI）已推动实施一项RRS，以便为住院患者提供更安全的护理。此外，联合委员会将实施RRS作为2008年国家患者安全目标。虽然是强制性的，但支持RRS在减少医院内科或外科地板的心脏骤停、意外ICU转移和所有医院死亡率方面的有效性的证据仍然没有定论，部分原因是研究设计薄弱，部分原因是已发表的研究未能报告其干预措施的所有关键方面。最近，两份已发表的报告为已发表的RRS研究中需要包括的方法学组成部分制定了指导方针。本研究将遵循这些准则来评估在马萨诸塞大学纪念医学中心（UMMMC）的两个校区实施RRS的有效性和实施情况。提出的研究的具体目的是：1)评估RRS的有效性，使用前/后研究，旨在测量心脏骤停率的变化，意想不到的ICU从楼层入院，医院死亡率和紧急呼叫楼层。在实施前的这段时间，将包括对实施RSS前12个月的审查。之后的一段时间将是对RSS实施后的24个月进行检讨。2)对RRS干预措施进行过程评价，评估RRS实施的保真度、RRS达到的预期患者群体比例、实施的RRS呼叫总数（交付的剂量）以及受RRS影响的医院工作人员对RRS的可接受性和满意度以及使用障碍的看法。了解资源分配比率的有效性和实施将有助于类似机构实施或改进资源分配比率。

DESCRIPTION (provided by applicant): The Institute for Healthcare Improvement (IHI) has promoted implementing a RRS to provide safer care for hospitalized patients. Additionally, the Joint Commission made implementing a RRS a 2008 National Patient Safety Goal. Although mandated, the evidence to support the effectiveness of a RRS to reduce cardiac arrests on hospital medical or surgical floors, un-anticipated ICU transfers and all hospital mortality rates remains inconclusive, partly because of weak study designs and partly due to a failure of published studies to report all critical aspects of their intervention. Recently, two published reports have set guidelines for the methodological components that need to be included in published studies of RRS. This study will follow these guidelines to evaluate the effectiveness and the implementation of a RRS on the two campuses of the UMass Memorial Medical Center (UMMMC). The Specific Aims of the proposed research are to: 1) To evaluate the effectiveness of a RRS using a before/after study designed to measure changes in rates of cardiac arrest, un-anticipated ICU admissions from the floors, hospital mortality and code calls to the floor. The before period will consist of a review of the 12 months prior to the implementation of the RSS. The after period will be a review of the 24 months following the implementation of the RSS. 2) To conduct a process evaluation of the RRS intervention that will assess fidelity of RRS implementation, the proportion of the intended patient population that is reached by the RRS, the overall number of RRS calls implemented (dose delivered) and the perceptions of the hospital staff affected by the RRS with respect to acceptability and satisfaction with the RRS and barriers to utilization. An understanding of the effectiveness and the implementation of an RRS will help similar institutions implement or improve an RRS. PUBLIC HEALTH RELEVANCE: Studies have shown that there are often observable clinical antecedents (patient signs and symptoms) to cardiac and respiratory arrests and to ICU admission of patients receiving care on general hospital floors. Other evidence suggests that hospital clinical staff often do not respond effectively to these antecedent clinical findings. In theory, rapid response systems aimed at detection of these antecedents and effective management of the underlying cause/s may reduce the incidence of cardiac and respiratory arrests, of urgent, unplanned ICU admissions, and of in-hospital death among patients hospitalized outside of ICUs. However, evidence on the effectiveness of rapid response systems is limited and the optimal design of the systems is not known. Hospital staff time and energy are limited public health resources that should be allocated in the most cost effective manner. The proposed evaluation of a rapid response system will provide valid measures of the effectiveness of the intervention as well as an understanding of the operation and contribution of the components to the outcomes. The study findings will inform the ongoing national discussion about the benefits and costs of rapid response systems, and may ultimately contribute to a more efficient allocation of the relevant public health resources.