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Hu Li Za Zhi ; 67(1): 6-11, 2020 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-31960391


Related studies in the literature indicate that over half (50-84%) of patients exhibit physiological variations 6 hours before experiencing cardiac arrest. Early warning systems improve the ability of medical teams to detect patient deterioration and then immediately treat sudden cardiac arrest during patient hospitalization. This article aims to strengthen general understanding among clinical medical staffs of the early warning system. Understanding the reasons and motivations for establishing this system is expected to help readers better distinguish the physiological monitoring indicators of this system and its importance in terms of improving patient safety. In particular, using the system to identify patients at risk levels of medium or higher will help facilitate their timely transfer to an intensive care unit for appropriate monitoring and care. This article further explores the application of early warning systems in nursing to help nurses understand their professional roles and responsibilities as members of the rapid-response team. Finally, information in this article teaches medical staffs how to avoid unanticipated cardiac arrest events, create a comprehensive patient safety environment, and improve the quality of medical care.

Deterioração Clínica , Diagnóstico Precoce , Parada Cardíaca/prevenção & controle , Equipe de Respostas Rápidas de Hospitais/organização & administração , Humanos , Papel do Profissional de Enfermagem
Medicine (Baltimore) ; 98(52): e18475, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876731


Rapid response system (RRS) efficacy and national early warning score (NEWS) performances have largely been reported in inpatient settings, with few such reports undertaken in outpatient settings.This study aimed to investigate NEWS validity in predicting poor clinical outcomes among outpatients who had activated the RRS using single-parameter criteria.A single-center retrospective cohort studyFrom April 1, 2014 to November 30, 2017 in an urban 350-bed referral hospital in JapanWe collected patient characteristics such as activation triggers, interventions, arrival times, dispositions, final diagnoses, and patient outcomes. Poor clinical outcomes were defined as unplanned intensive care unit transfers or deaths within 24 hours. Correlations between the NEWS and clinical outcomes at the time of deterioration and disposition were analyzed.Among 31 outpatients, the NEWS value decreased significantly after a medical emergency team intervention (median, 8 vs 4, P < .001). The difference in the NEWS at the time of deterioration and at disposition was significantly less in patients with poor clinical outcomes (median 3 vs 1.5, P = .03). The area under the curve (AUC) for the NEWS high-risk patient group at the time of deterioration for predicting hospital admission was 0.85 (95% confidence interval [CI], 0.67-1.0), while the AUC for the NEWS high-risk patient group at disposition for predicting poor clinical outcomes was 0.83 (95% CI, 0.62-1.0).The difference between the NEWS at the time of deterioration and at disposition might usefully predict admissions and poor clinical outcomes in RRS outpatient settings.

Assistência Ambulatorial/métodos , Equipe de Respostas Rápidas de Hospitais , Triagem/métodos , Idoso , Deterioração Clínica , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
BMC Health Serv Res ; 19(1): 639, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488141


BACKGROUND: The Australian Commission on Safety and Quality in Health Care released a set of national standards which became a mandatory part of accreditation in 2013. Standard 9 focuses on the identification and treatment of deteriorating patients. The objective of the study was to identify changes in the characteristics and perceptions of rapid response systems (RRS) since the implementation of Standard 9. METHODS: Cross-sectional study of Australian hospitals. Baseline data was obtained from a pre-implementation survey in 2010 (220 hospitals). A follow-up survey was distributed in 2015 to staff involved in implementing Standard 9 in public and private hospitals (276 responses) across Australia. RESULTS: Since 2010, the proportion of hospitals with formal RRS had increased from 66 to 85. Only 7% of sites had dedicated funding to operate the RRS. 83% of respondents reported that Standard 9 had improved the recognition of, and response to, deteriorating patients in their health service, with 51% believing it had improved awareness at the executive level and 50% believing it had changed hospital culture. CONCLUSIONS: Implementing a national safety and quality standard for deteriorating patients can change processes to deliver safer care, while raising the profile of safety issues. Despite limited dedicated funding and staffing, respondents reported that Standard 9 had a positive impact on the care for deteriorating patients in their hospitals.

Deterioração Clínica , Equipe de Respostas Rápidas de Hospitais/normas , Acreditação/normas , Austrália , Estudos Transversais , Hospitais Privados/normas , Hospitais Públicos/normas , Humanos , Cultura Organizacional , Padrões de Referência , Inquéritos e Questionários
Emergencias (Sant Vicenç dels Horts) ; 31(4): 270-280, ago. 2019. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-182769


El objetivo de esta revisión narrativa fue elaborar un documento que trate los aspectos clave del ahogamiento de acuerdo con la evidencia científica disponible. El ahogamiento se define como el proceso de sufrir dificultades respiratorias por sumersión/inmersión en un líquido. El tiempo de sumersión es un factor clave en la supervivencia y daño neurológico. Aunque el distrés respiratorio e hipoxia es el cuadro predominante, pueden presentarse otras complicaciones que afecten a distintos sistemas y aparatos. El ahogamiento es una de las principales causas de muerte accidental en el mundo. Sin embargo, la mortalidad por ahogamiento está infraestimada y la morbilidad desconocida. La prevención es el factor clave para la reducción de la mortalidad y morbilidad, pero si esta falla, la rapidez y calidad del tratamiento tanto prehospitalario como hospitalario determinarán el pronóstico. Por tanto, resulta fundamental conocer los factores y mecanismos particulares implicados en esta emergencia

This narrative review discusses the evidence relevant to key aspects of drowning, which is defined by the World Health Organization as the process of respiratory difficulty caused by submersion/immersion in liquid. The length of time the victim is submerged is a key factor in survival and neurologic damage. Although respiratory distress and hypoxia are the main events, other complications affecting various systems and organs may develop. Drowning is one of the main causes of accidental death worldwide, yet deaths from drowning are underestimated and morbidity is unknown. Prevention is essential for reducing both mortality and morbidity, but if prevention fails, the speed of access to and the quality of prehospital and hospital care will determine the prognosis. It is therefore essential to understand the factors and mechanisms involved in these emergencies

Humanos , Afogamento/epidemiologia , Afogamento/prevenção & controle , Serviços Médicos de Emergência , Fatores de Risco , Afogamento/fisiopatologia , Assistência Pré-Hospitalar , Espanha/epidemiologia , Reanimação Cardiopulmonar/métodos , Equipe de Respostas Rápidas de Hospitais
J Clin Nurs ; 28(21-22): 4139-4149, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31327164


BACKGROUND: To optimise care of deteriorating patients, healthcare organisations have implemented rapid response systems including an "afferent" and "efferent" limb. Afferent limb behaviours include monitoring vital signs and escalating care. To strengthen afferent limb behaviour and reduce adverse patient outcomes, the National Early Warning Score was implemented in the UK. There are no published reports of how National Early Warning Score guidance has translated into trust-level deteriorating patient policy and whether these documents provide clear, actionable statements guiding staff. AIM: To identify how deteriorating patient policy documents provide "actionable" behavioural instruction for staff, responsible for actioning the afferent limb of the rapid response system. DESIGN: A structured content analysis of a national guideline and local policies using a behaviour specification framework. METHODS: Local deteriorating patient policies were obtained. Statements of behaviour were extracted from policies; coded using a behaviour specification framework: Target, Action, Context, Timing and Actor and scored for specificity (1 = present, nonspecific; 2 = present, specific). Frequencies and proportions of statements containing elements of the Target, Action, Context, Timing and Actor framework were summarised descriptively. Reporting was guided by the COREQ checklist. RESULTS: There were more statements related to monitoring than escalation behaviour (65% vs 35%). Despite high levels of clear specification of the action (94%) and the target of the behaviour (74%), context, timing and actor were poorly specified (37%, 37% and 33%). CONCLUSION: Delay in escalating deteriorating patients is associated with adverse outcomes. Some delay could be addressed by writing local protocols with greater behavioural specificity, to facilitate actionability. RELEVANCE TO CLINICAL PRACTICE: Numerous clinical staff are required for an effective response to patient deterioration. To mitigate role confusion, local policy writers should provide clear specification of the actor. As the behaviours are time-sensitive, clear specification of the time frame may increase actionability of policy statements for clinical staff.

Deterioração Clínica , Políticas , Guias de Prática Clínica como Assunto , Equipe de Respostas Rápidas de Hospitais , Humanos , Fatores de Tempo , Sinais Vitais
Crit Care Nurs Q ; 42(3): 227-234, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31135473


In response to national and local drivers, a clinical emergency response system (CERS) incorporating an intensivist-led rapid response team (RRT) was implemented at a Sydney (Australia) hospital. The authors present a pragmatic evaluation of the 5 years since this major initiative was commenced. A "partner not conquer" philosophy was adopted. Implementation of the RRT was based on a collaborative pragmatic quality improvement approach. A team of intensive care specialist trained medical doctors (n = 2) and clinical nurse consultants (n = 2) set up the service with executive support and funding. Roles and responsibilities were clearly detailed, reinforcing a positive, partnership-driven culture. A constantly evolving education strategy was a critical element of implementation and maintenance. Ongoing evaluation includes process and patient outcome data. Serious patient deterioration-related incidents have decreased significantly (from 7 to 1 per year) and the RRT has been universally accepted by clinicians. Key lessons learned include the need for specific protected funding, a partnership approach ensuring hospital clinicians retain responsibility of patient treatment, ongoing education and reinforcement, and strong nursing leadership. However, generalizations cannot be made about the implementation of the CERS. It is important to consider context; "one size does not fit all."

Enfermagem de Cuidados Críticos , Cuidados Críticos/organização & administração , Equipe de Respostas Rápidas de Hospitais/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Avaliação de Programas e Projetos de Saúde , Austrália , Deterioração Clínica , Hospitais , Humanos , Melhoria de Qualidade
Crit Care Nurs Q ; 42(3): 235-245, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31135474


The objective of this study was to investigate the difference in mortality and length of stay between patients who experienced a delay in rapid response system (RRS) activation and those who did not. A retrospective comparative cohort study investigated all adult inpatient cases that experienced an RRS activation from January 1, 2017, through January 1, 2018. Cases experiencing a delay in RRS activation were compared with cases without delay. During the study period a total of 3580 RRS activations that took place and 1086 RRS activations met inclusion criteria for analysis. Delayed RRS activations occurred in 325 cases (29.8%) and nondelayed RRS activations occurred in 766 cases (70.2%). The mean age was roughly the same for both groups (60 years old) and both groups consisted of approximately 60% males. Delay in activation was significantly associated with an increase in length of hospitalization (19.9 days vs 32.4 days; P < .001) and also a higher likelihood of not surviving hospitalization (hazard ratio = 2.70; 95% confidence interval, 1.96-3.71; P < .001). This study demonstrates that delayed RRS activation occurs frequently and exposes patients to higher mortality and longer length of hospitalization.

Deterioração Clínica , Equipe de Respostas Rápidas de Hospitais/organização & administração , Tempo de Internação/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
Intensive Crit Care Nurs ; 53: 100-108, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076253


AIM: This study aims to understand the concerns of nurses when making MET calls which did not fulfil the vital sign criteria, and the MET nurses subsequent responses to these calls. METHODS: This was a retrospective report-based study. Research material included nursing reports and MET forms related to MET calls made due to nurses' concern. Inductive content analysis was used to identify observations, which were then quantified based on the research material. FINDINGS: From a total of 546 MET calls, 39 visits (7%) were due to nurses' concern. In these 39 visits, the vital sign criteria did not reach the alert threshold, but nurses made the call due to subjective worry. In 13% of visits, the alert concern was inadequate contact with the doctor. MET nurses responded to the alert by providing clinical and indirect nursing; more specifically, they performed examinations and nursing interventions and collaborated with other professionals. CONCLUSION: A nurse's worry is influenced by subjective changes in the patient's condition or an inadequate doctor's response rather than objective physiological measurements. A MET nurse's ability to assess patient condition, respond to nurses' calls, and acknowledge justified alerts help MET nurses support concerned nurses and encourage them to contact the MET if necessary.

Diagnóstico Precoce , Serviços Médicos de Emergência/normas , Equipe de Respostas Rápidas de Hospitais/normas , Relações Interprofissionais , Recursos Humanos de Enfermagem no Hospital/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Estudos de Coortes , Continuidade da Assistência ao Paciente , Serviços Médicos de Emergência/métodos , Feminino , Finlândia , Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Quartos de Pacientes/organização & administração , Quartos de Pacientes/estatística & dados numéricos , Estudos Retrospectivos , Sinais Vitais/fisiologia , Local de Trabalho/psicologia , Local de Trabalho/normas
J Nurs Adm ; 49(6): 297-302, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31090558


OBJECTIVE: To synthesize articles exploring the implementation of psychiatric rapid response teams (RRTs) for behavioral crises in hospital settings. BACKGROUND: Psychiatric/behavioral crises in nonpsychiatric hospital settings can lead to restraint use, staff injuries, and poor patient outcomes. Psychiatric RRTs may provide a solution, but they are a new, understudied intervention, and their implementation varies across institutions. METHODS: A systematic, integrative literature review of nursing and biomedical literature yielded 7 articles about psychiatric RRTs. Data were extracted on RRT structure, processes, outcomes, and implementation. RESULTS: Psychiatric RRTs were structured as a nurse-led, interdisciplinary intervention. When implemented using evidence-based models, they reduced security calls, restraint use, and staff injuries while moderately improving staff knowledge and self-efficacy. RRTs that included education, debriefing, and role modeling appeared to increase staff behavioral management skills and eventually reduced the need for RRTs. CONCLUSIONS: Psychiatric RRTs have demonstrated promise in quality improvement projects for reducing adverse outcomes related to behavioral health in hospitals.

Intervenção na Crise , Serviços de Emergência Psiquiátrica/organização & administração , Equipe de Respostas Rápidas de Hospitais/organização & administração , Comportamento Problema , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
Int J Nurs Stud ; 94: 166-178, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31002971


BACKGROUND: Despite widespread adoption of rapid response systems and the use of various early warning scoring systems, the detection of patient deterioration remains suboptimal, leading to the development of potentially avoidable serious adverse events. Why this occurs has been the focus of many investigations, but the complexities around advancing understanding that leads to effective actions are less evident. OBJECTIVE: To better understand medical/surgical nurses use of early warning scoring systems. DESIGN: A five-step process was used in this scoping review including: identify the research question; search and identify the relevant studies; selecting relevant studies; charting the data; and collate, summarize and report the results. The PRISMA extension for scoping reviews was used to guide this scoping review. DATA SOURCES: In August 2018 a literature search was performed using the following medical subject headings: physiological, clinical deterioration, and the expanders early warning score, system, nurse attitudes, with Boolean operators in Ovid MEDLINE, CINAHL, and EMBASE databases. REVIEW METHODS: Extracted data included study aims, key findings, afferent/efferent focus and rapid response team description. Effective practice and organisation of care taxonomy guided data synthesis, before a thematic analysis was performed. RESULTS: Of 120 unique articles, 23 were included in the scoping review (11 qualitative, 8 quantitative and 4 mixed methods studies). Fifteen studies focused on the afferent limb of the rapid response system whilst eight focused on both the afferent and efferent limbs. In the effective practice and organisation of care taxonomy twenty-two studies met criteria for quality and safety improvements while nineteen met criteria for referral, outreach and teams. Three themes, Inconsistent activation of the rapid response team; Barriers to following early warning scoring system algorithms; and Overreliance on scores emerged. CONCLUSION: Nurses aim to use early warning score systems to detect deterioration and ensure patient safety, however cultures, confidence and past experiences impact on rates of afferent limb failure globally. Simple to follow algorithms used in track and trigger charts are likely difficult for nurses to adhere to due to heavy workloads and challenges in getting medical officers to review within recommended time frames. Nurses rely heavily on the scores generated by early warning score systems but should aim to follow algorithms better and undertake holistic physical assessments to detect deterioration earlier and ensure patient safety is not compromised.

Deterioração Clínica , Recursos Humanos de Enfermagem no Hospital , Segurança do Paciente , Competência Clínica , Equipe de Respostas Rápidas de Hospitais , Humanos
Rev. pesqui. cuid. fundam. (Online) ; 11(3): 634-640, abr.-maio 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-994678


Objective: The study's purpose has been to describe the knowledge and performance of an urgency nursing team of the University Hospital from the Universidade Federal do Vale do São Francisco in Petrolina city, Pernambuco State, with regards to the cardio respiratory arrest event. Methods: It is a descriptive and cross-sectional study with a quantitative approach, which was carried out through a non-probabilistic sample of 101 nursing professionals who answered a questionnaire. Data were analyzed by observing the frequencies of each isolated response and the crossing of variables. Results: Twenty-three nurses and 78 nurse technicians were interviewed. Regarding the detection of a cardio respiratory arrest, immediate conduct, and the actions of both the basic life support and advanced life support, most professionals answered in a partially correct way. Conclusion: The low percentage of totally correct answers evidences the need to update the entire nursing team, maintaining the uniformity of the professional performance, thus improving the care provided to the patient showing serious health condition

Objetivo: Descrever o conhecimento e atuação da equipe de enfermagem da urgência do Hospital Universitário da Universidade Federal do Vale do São Francisco de Petrolina/PE, perante o evento PCR. Métodos: Estudo quantitativo, descritivo e transversal por uma amostragem não probabilística de 101 profissionais de enfermagem que responderam a um questionário. Os dados foram analisados por meio da observação das frequências de cada resposta isolada e do cruzamento de variáveis. Resultados: Foram entrevistados 23 enfermeiros e 78 técnicos de enfermagem. Com relação à detecção de PCR, conduta imediata, ações de SBV e SAV, a maioria dos profissionais respondeu de maneira parcialmente correta. Conclusão: O baixo percentual de respostas totalmente corretas, evidencia a necessidade de atualização de toda a equipe de enfermagem, mantendo a uniformidade das condutas, melhorando assim o atendimento prestado ao paciente grave

Objetivo: Describir el conocimiento y actuación del equipo de enfermería de la urgencia del Hospital Universitario de la Universidad Federal del Valle del São Francisco de Petrolina / PE, ante el evento PCR. Métodos: Estudio cuantitativo, descriptivo y transversal por un muestreo no probabilístico de 101 profesionales de enfermería que respondieron a un cuestionario. Los datos fueron analizados por medio de la observación de las frecuencias de cada respuesta aislada y del cruce de variables. Resultados: Fueron entrevistados 23 enfermeros y 78 técnicos de enfermería. Con respecto a la detección de PCR, conducta inmediata, acciones de SBV y SAV, la mayoría de los profesionales respondió de manera parcialmente correcta. Conclusión: El bajo porcentaje de respuestas totalmente correctas, evidencia la necesidad de actualización de todo el equipo de enfermería, manteniendo la uniformidad de las conductas, mejorando así la atención prestada al paciente grave

Humanos , Masculino , Feminino , Adulto , Reanimação Cardiopulmonar/enfermagem , Parada Cardíaca/terapia , Reanimação Cardiopulmonar/instrumentação , Equipe de Respostas Rápidas de Hospitais , Parada Cardíaca/enfermagem , Equipe de Enfermagem/estatística & dados numéricos
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2 (Supl)): 187-191, abr.-jun. 2019. tab, ilus
Artigo em Português | LILACS | ID: biblio-1009725


Times de Resposta Rápida (TRR) são equipes multidisciplinares treinadas para atender indivíduos com intercorrências agudas e graves, incluindo parada cardiorrespiratória (PCR) súbita, nas unidades de internação. O objetivo deste trabalho é discutir as particularidades do emprego de um TRR hospitalar no atendimento de PCRs extra-hospitalares, utilizando a experiência do time do Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICHC-FMUSP) para elucidação. Metodologia: Estudo retrospectivo, descritivo, utilizando o banco de dados do TRR do ICHC-FMUSP. Foram levantados todos os casos classificados como PCR súbita atendidos em ambiente extra-hospitalar, nos anos de 2014 a 2016. Dados globais de cinco pacientes que evoluíram com alta hospitalar e nível neurológico preservado foram descritos e analisados em detalhes. Resultados: Entre 11 atendimentos, oito tiveram retorno da circulação espontânea (RCE) na cena (72,2%) e três morreram no local. Dos oito pacientes admitidos com vida no Departamento de Emergência, cinco tiveram alta hospitalar após o evento (45,5%). A média de tempo de resposta foi 3 ± 1,2 minutos e o intervalo chamada-choque foi de 7,25 ± 3,2 minutos. Os ritmos de parada foram fibrilação ventricular (80%) e atividade elétrica sem pulso (20%). Dois pacientes foram diagnosticados com doença coronariana grave e quatro receberam um cardiodesfibrilador implantável (CDI) para profilaxia secundária de morte súbita. Um paciente, entre os cinco que tiveram alta, faleceu em outro serviço. Conclusão: Apesar de pouco usual, o emprego de um TRR hospitalar no atendimento de PCRs extra-hospitalares pode ser benéfico. Os desfechos favoráveis provavelmente decorreram do treinamento da equipe e da rapidez na realização do atendimento. A investigação cardiológica dos sobreviventes identificou pacientes com doenças graves, que, portanto, mais se beneficiariam da assistência de um time especializado

Introduction: Rapid Response Teams (RRT) are multidisciplinary groups trained to treat individuals with severe and acute events, including sudden cardiac arrest (CA), in in-patient units. The aim of this report is to discuss the singularities of deploying a hospital RRT for out-of-hospital CA assistance, using the experience of the team at the Instituto Central of Hospital das Clínicas of the University of São Paulo School of Medicine (ICHC-FMUSP) as illustration. Methodology: A retrospective, descriptive analysis was conducted, using the RRT database of the ICHC-FMUSP. All cases classified as sudden CA treated outside of the hospital between 2014 and 2016 were surveyed. Global data for five patients who progressed to discharge from hospital free of neuro - logical impairment were described and analyzed in detail. Results: Of the 11 cases, 8 had return of spontaneous circulation (ROSC) at the scene (72.2%), and 3 died on site. Of the 8 patients admitted to the Emergency Department, 5 were discharged from the hospital after the event (45.5%). The average response time was 3±1.2minutes, and the call-to-shock time interval was 7.25±3.2minutes. The cardiac arrest rhythms were ventricular fibrillation (80%) and pulseless electrical activity (20%). Two patients were diagnosed with severe coronary disease and four received an implantable cardioverter-defibrillator (ICD) for secondary prophylaxis of sudden death. One patient, of the 5 discharged, died in another unit. Conclusion: Although unusual, the use of a hospital RRT for out-of-hospital CA assistance can be beneficial. The favorable outcomes likely resulted from the team's training and the speed with which the treatment was given. Cardiovascular evaluation of the survivors identified patents with severe diseases, which would, therefore, most benefit from the care of a specialized team

Humanos , Masculino , Feminino , Idoso , Equipe de Respostas Rápidas de Hospitais , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca , Fibrilação Ventricular/complicações , Doença da Artéria Coronariana/complicações , Ecocardiografia/métodos , Espectroscopia de Ressonância Magnética/métodos , Doenças Cardiovasculares/mortalidade , Estudos Retrospectivos , Morte Súbita Cardíaca , Desfibriladores Implantáveis , Eletrocardiografia/métodos , Unidades de Internação
Rev. enferm. Inst. Mex. Seguro Soc ; 27(2): 80-88, Abr-Jun 2019. tab
Artigo em Espanhol | LILACS, BDENF - Enfermagem | ID: biblio-1015227


Introducción: el personal de enfermería es esencial para la atención oportuna en el programa Código Infarto. La evaluación por competencias es la clave para garantizar la calidad de los servicios de salud. Objetivo: evaluar las dimensiones de la competencia clínica del personal de enfermería para el protocolo de Código Infarto en una unidad de tercer nivel de atención. Métodos: estudio descriptivo transversal, en el que se incluyeron 80 miembros del personal de enfermería de los servicios de Admisión y Hemodinamia. Se diseñó y validó un instrumento de 48 ítems mediante ronda de expertos 3/3; para determinar el nivel de competencia clínica, se utilizó la teoría de Patricia Benner. Resultados: el nivel de competencia clínica fue competente en 38.8%. En las dimensiones, el área de conocimiento obtuvo 83.4%, habilidad 86.7% y actitud 87.2%. Se asoció el nivel de competencia con capacitación, grado académico y categoría (p < 0.001). Conclusiones: se identificaron áreas de oportunidad respecto a la dimensión de conocimiento, lo cual permite redireccionar los procesos educativos dirigidos al personal de enfermería.

Introduction: Nursing staff is essential in providing timely care in Código Infarto (Infarction Code) program. Competency assessment is the key to guarantee the quality of health services. Objective: To assess the clinical competence of Código Infarto nursing staff in a third-level unit. Methods: Cross-sectional analytical study, which included 80 members of the nursing staff of Admission and Cardiac Care; a 48-item instrument was designed and validated by experts in three rounds; Patricia Benner's theory was used to determine the level of clinical competence. Results: The level of clinical competence was competent (38.8%). In the dimensions, the area of knowledge obtained 83.4%, ability 86.7%, and attitude 87.2%. The level of competence was associated with training, academic degree and category (p < 0.001). Conclusions: Opportunity areas regarding knowledge were identified, which allows redirecting the educational processes addressed to the nursing staff.

Humanos , Avaliação de Processos e Resultados (Cuidados de Saúde) , Epidemiologia Descritiva , Estudos Transversais , Enfermagem , Competência Clínica , Equipe de Respostas Rápidas de Hospitais , Serviços de Saúde , Hospitais Especializados , Infarto , Recursos Humanos de Enfermagem , México
Qual Manag Health Care ; 28(2): 78-83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30921281


BACKGROUND: Standardized hospital mortality ratios (SHMRs) are widely used for quality improvement, hospital ratings, and health care payment. OBJECTIVES: (1) To characterize the programs implemented at hospitals in response to SHMRs.(2) To describe hospital leaders' perceptions of SHMRs as indicators of care quality. METHODS: Electronic survey of administrative leaders at US academic medical centers who subscribed to Vizient leadership networks. RESULTS: Forty-seven administrative leaders from 37 US academic medical centers completed the survey. Respondents reported that SHMRs had the largest role in the decision to implement inpatient hospice programs, electronic early warning systems, and clinical documentation specialist programs at their institution. Respondents perceived clinical documentation specialist programs and condition-specific care pathways as the most effective programs to improve performance on SHMRs. Only 29% of respondents agreed that SHMRs accurately reflect the number of preventable deaths in hospitals, but 78% agreed that SHMRs have helped their hospital reduce preventable deaths. CONCLUSIONS: Hospitals have employed various strategies in response to SHMRs-including clinical programs that focus on reducing preventable deaths and other programs that target improvement in SHMR performance without reducing preventable deaths. Hospital administrative leaders identify significant benefits and flaws of SHMRs as quality indicators.

Administração Hospitalar , Administradores Hospitalares/organização & administração , Mortalidade Hospitalar/tendências , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Centros Médicos Acadêmicos , Procedimentos Clínicos/normas , Documentação/normas , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Equipe de Respostas Rápidas de Hospitais/organização & administração , Humanos , Liderança , Admissão e Escalonamento de Pessoal/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Estados Unidos
PLoS One ; 14(3): e0213146, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30835759


INTRODUCTION: This study aimed to determine the occurrence rate and risk factors of cardiopulmonary arrest (CPA) during intra-hospital transport (IHT) among critically ill patients, accompanied by a rapid response team (RRT). METHODS: We performed a retrospective cohort study in a 1300-bed tertiary-care teaching hospital. Data of all admitted patients transported within the hospital and accompanied by the RRT from October 2012 to May 2016 were included. We compared patients with CPA (+) and patients without CPA (-) to identify risk factors for CPA during transport. RESULTS: Among 535 patients, CPA occurred in eight (1.5%) patients during IHT. There were no significant differences in age, sex, and comorbidities between groups. More patients in the CPA (+) group than in the CPA (-) group received manual ventilation during IHT (75% vs. 23.0%, p = 0.001). An increased risk of CPA (p<0.001) corresponded with a higher number of vasopressors used during IHT. In univariate logistic regression analysis, history of myocardial infarction (OR 10.7, 95% CI 2.4-50.5, p = 0.005), manual ventilation (OR 10.1, 95% CI 2.0-50.5, p = 0.005), and use of three or more vasopressors (OR 11.1, 95% CI 2.5-48.9, p = 0.001) were significantly associated with risk of CPA during RRT-led IHT. CONCLUSIONS: Despite accompaniment by a specialized team such as the RRT, CPA can occur during IHT. History of myocardial infarction, manual ventilation with bag-valve mask, and the use of three or more vasopressors were independent risk factors of CPA during IHT of critically ill patients accompanied by the RRT.

Parada Cardíaca/epidemiologia , Transferência de Pacientes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Feminino , Parada Cardíaca/etiologia , Equipe de Respostas Rápidas de Hospitais , Hospitais de Ensino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária
J Nurs Care Qual ; 34(4): 325-329, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817415


BACKGROUND: Operationalization of the rapid response team (RRT) and its quality champion (QC) nurses at a community hospital is unique and provides benefits not entirely captured by analysis of mortality data. PURPOSE: The purpose was to determine the perceived benefits of the RRT at the facility and behaviors and activities observed during actual RRT responses. Also examined was the timeliness of the RRT calls. METHODS: This was a mixed-method study including qualitative (interviews, focus groups, and surveys) and quantitative (retrospective chart reviews) data collection. RESULTS: Themes included teaching/education, foster development of critical thinking skills, expertise/resource, communication/facilitation/go-between, safety net/security, validation, and advocate/foster collaboration. RRT calls were made quickly after clinical deterioration. CONCLUSIONS: Benefits of the RRT-QC registered nurse were extensive. Observations showed support, education, and teamwork in an effort to improve outcomes and support clinicians.

Atitude do Pessoal de Saúde , Competência Clínica/normas , Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Papel do Profissional de Enfermagem/psicologia , Feminino , Grupos Focais , Hospitais Comunitários , Humanos , Recursos Humanos de Enfermagem no Hospital/educação , Pesquisa Qualitativa , Estudos Retrospectivos , Inquéritos e Questionários , Tempo para o Tratamento/estatística & dados numéricos