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4.
Medicine (Baltimore) ; 99(10): e19032, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150050

RESUMO

Rapid response teams have been adopted to prevent unexpected in-ward cardiac arrest. However, there is no convincing evidence of optimal operation with rapid response team. Our aim was to address the impact of focused rapid response team on the safety of patients in wards. Comparison of focused with extended rapid response teams was performed in single center. The extended team operated on adult patients in whole ward (both medical and nonmedical ward) 24 hours per day, 7 days per week during 2012. In 2015, the operational time of the focused team was office hours from Monday to Friday and study population were limited to adult patients in the nonmedical ward. Unexpected in-ward cardiac arrests were compared between the extended team and focused team periods. During the focused team period, there was significant reduction in cardiac arrest per 1000 admissions in whole ward compared to the before the rapid response team period (1.09 vs 1.67, P < .001). Compared to that of the extended team period (1.42), there was also a significant reduction in cardiac arrest rate (P = .04). The cardiac arrest rate of nonmedical ward patients was also significantly decreased in the focused team period compared to that before the rapid response team period (0.43 vs 0.95, P < .001). Compared to the extended team period (0.64), there was a marginally significant reduction in cardiac arrest of nonmedical ward patients (P = .05). The focused rapid response team was associated with a reduced incidence of unexpected in-ward cardiac arrest. Further research on the optimal composition and operational time is needed.


Assuntos
Parada Cardíaca/prevenção & controle , Equipe de Respostas Rápidas de Hospitais/normas , Avaliação de Resultados em Cuidados de Saúde , Adulto , China , Feminino , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Hospitalização , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Quartos de Pacientes , Estudos Prospectivos , Melhoria de Qualidade
6.
Scand J Trauma Resusc Emerg Med ; 27(1): 111, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842961

RESUMO

BACKGROUND: The national early warning score (NEWS) enables early detection of in-hospital patient deterioration and timely activation of hospital's rapid response team (RRT). NEWS was updated in 2017 to include a separate SpO2 scale for those patients with type II respiratory failure (T2RF). In this study we investigated whether NEWS with and without the new SpO2 scale for the T2RF patients is associated with immediate and in-hospital patient outcomes among the patients actually attended by the RRT. METHODS: We conducted a two-year prospective observational study including all adult RRT patients without limitations of medical treatment (LOMT) in a large Finnish university associated tertiary level hospital. According to the first vital signs measured by the RRT, we calculated NEWSs for the RRT patients and further utilized the new SpO2 scale for the patients with confirmed T2RF. We used multivariate logistic regression and area under the receiver operating characteristic analyses to test NEWS's accuracy to predict two distinct outcomes: RRT patient's I) immediate need for intensive care and/or new LOMT and 2) in-hospital death or discharge with cerebral performance category >2 and/or LOMT. RESULTS: The final cohort consisted of 886 RRT patients attended for the first time during their hospitalization. Most common reasons for RRT activation were respiratory (343, 39%) and circulatory (226, 26%) problems. Cohort's median (Q1, Q3) NEWS at RRT arrival was 8 (5, 10) and remained unchanged if the new SpO2 scale was applied for the 104 patients with confirmed T2RF. Higher NEWS was independently associated with both immediate (OR 1.28; 95% CI 1.22-1.35) and in-hospital (1.15; 1.10-1.21) adverse outcomes. Further, NEWS had fair discrimination for both the immediate (AUROC 0.73; 0.69-0.77) and in-hospital (0.68; 0.64-0.72) outcomes. Utilizing the new SpO2 scale for the patients with confirmed T2RF did not improve the discrimination capability (0.73; 0.69-0.76 and 0.68; 0.64-0.71) for these outcomes, respectively. CONCLUSIONS: We found that in patients attended by a RRT, the NEWS predicts patient's hospital outcome with moderate accuracy. We did not find any improvement using the new SpO2 scale in T2RF patients.


Assuntos
Escore de Alerta Precoce , Equipe de Respostas Rápidas de Hospitais/normas , Insuficiência Respiratória/terapia , Adulto , Idoso , Estudos de Coortes , Cuidados Críticos , Diagnóstico Precoce , Estudos de Avaliação como Assunto , Feminino , Finlândia , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Prospectivos , Curva ROC , Insuficiência Respiratória/fisiopatologia , Sinais Vitais
8.
J Nurses Prof Dev ; 35(6): 330-336, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31651556

RESUMO

A rural community hospital provided a pilot patient deterioration simulation education for new graduate nurses in an attempt to advance the utilization of an existing rapid response team. Pre- and post-intervention self-confidence scores demonstrated a large effect size and a clinically significant eta squared value (.48). The participants successfully completed most of the simulation competencies. This pilot project supports further studies exploring new graduate nurses' self-confidence levels and competency performance with patient deterioration simulation education.


Assuntos
Competência Clínica/normas , Deterioração Clínica , Recursos Humanos de Enfermagem/educação , Simulação de Paciente , Autoimagem , Bacharelado em Enfermagem , Equipe de Respostas Rápidas de Hospitais/normas , Humanos , Projetos Piloto , Inquéritos e Questionários
9.
BMC Health Serv Res ; 19(1): 639, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488141

RESUMO

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.


Assuntos
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
11.
Simul Healthc ; 14(4): 217-222, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31116168

RESUMO

INTRODUCTION: Rapid response teams (RRTs) have become ubiquitous among hospitals in North America, despite lack of robust evidence supporting their effectiveness. Many RRTs do not yet use cognitive aids during these high-stakes, low-frequency scenarios, and there are no standardized cognitive aids that are widely available for RRTs on medicine patients. We sought to design an emergency manual to improve resident performance in common RRT calls. METHODS: Residents from the New York University School of Medicine Internal Medicine Residency Program were asked to volunteer for the study. The intervention group was provided with a 2-minute scripted informational session on cognitive aids as well as access to a cognitive aid booklet, which they were allowed to use during the simulation. RESULTS: Resident performance was recorded and scored by a physician who was blinded to the purpose of the study using a predefined scoring card. Residents in the intervention group performed significantly better in the simulated RRT, by overall score (mean score = 7.33/10 and 6.26/10, respectively, P = 0.02), and by performance on the two critical interventions, giving the correct dose of naloxone (89% and 39%, respectively, P < 0.001) and checking the patient's blood glucose level (93% and 52%, respectively, P = 0.001). CONCLUSIONS: In a simulated scenario of opiate overdose, internal medicine residents who used a cognitive aid performed better on critical tasks than those residents who did not have a cognitive aid. The use of an appropriately designed cognitive aid with sufficient education could improve performance in critical scenarios.


Assuntos
Equipe de Respostas Rápidas de Hospitais/organização & administração , Medicina Interna/educação , Internato e Residência/organização & administração , Treinamento por Simulação/organização & administração , Adulto , Analgésicos Opioides/toxicidade , Competência Clínica , Overdose de Drogas/terapia , Feminino , Equipe de Respostas Rápidas de Hospitais/normas , Humanos , Internato e Residência/normas , Masculino , Folhetos , Método Simples-Cego
12.
Intensive Crit Care Nurs ; 53: 100-108, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31076253

RESUMO

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.


Assuntos
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
13.
Crit Care Resusc ; 21(1): 32-38, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30857510

RESUMO

OBJECTIVE: Standardised rapid response team (RRT) calling criteria may not be applicable to all patients, and thus, modifications of these criteria may be reasonable to prevent unnecessary calls. Little data are available regarding the efficacy or safety of modifying RRT calling criteria; therefore, this study aimed to detail the prevalence and characteristics of modifications to RRT call triggers and explore their relationship with patient outcomes. DESIGN AND OUTCOME MEASURES: A pilot retrospective cohort study within a convenience sample of patients attended by a hospital RRT between July and December 2014; rates of repeat RRT calling and in-hospital mortality were compared between patients with and without modifications to standard calling criteria. Secondary analyses examined four different types of modifications, narrowing or widening of existing physiological calling criteria, to observations without defined calling criteria, and others. All analyses were performed using multivariable regression. RESULTS: During the study period, 673 patients had RRT calls, of whom 620 (91.2%) had data available for analysis. The majority of study patients (393; 63.4%) had modifications documented. Patients with modifications were more likely to have repeat RRT calls (odds ratio [OR], 2.86; 95% CI, 1.69-4.85) and experience in-hospital mortality (OR, 2.16; 95% CI, 1.31-3.57) versus patients without modifications. In the secondary analyses, although all classes of modification had higher rates of repeat calling, none reached statistical significance. Mortality was associated with having modifications that were more conservative than the standard calling criteria (adjusted OR, 2.81; 95% CI, 1.31-6.08). CONCLUSION: Modifications to standard calling criteria were frequently made, but did not seem to prevent further RRT calls and were associated with increased mortality. These findings suggest that modifications should be made with caution.


Assuntos
Mortalidade Hospitalar , Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Equipe de Respostas Rápidas de Hospitais/normas , Humanos , Avaliação de Resultados em Cuidados de Saúde , Prevalência , Estudos Retrospectivos
14.
Hosp Pract (1995) ; 47(1): 42-45, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30409047

RESUMO

BACKGROUND: Rapid response teams (RRTs) improve mortality by intervening in the hours preceding arrest. Implementation of these teams varies across institutions. SETTING AND DESIGN: Our health-care system has two different RRT models at two hospitals: Hospital A does not utilize a proactive rounder while Hospital B does. We studied the patterns of RRT calls at each hospital focusing on the differences between night and day and during nursing shift transitions. RESULTS: The presence of proactive surveillance appeared to be associated with an increased total number of RRT calls with more than twice as many calls made at the smaller Hospital B than Hospital A. Hospital B had more calls in the daytime compared to the nighttime. Both hospitals showed a surge in the night-to-day shift transition (7-8am) compared to the preceding nighttime. Hospital A additionally showed a surge in calls during the day-to-night shift transition (7-8pm) compared to the preceding daytime. CONCLUSIONS: Differences in the diurnal patterns of RRT activation exist between hospitals even within the same system. As a continuously learning system, each hospital should consider tracking these patterns to identify their unique vulnerabilities. More calls are noted between 7-8am compared to the overnight hours. This may represent the reestablishment of the 'afferent' arm of the RRT as the hospital returns to daytime staffing and activity. Factors that influence the impact of proactive rounding on RRT performance may deserve further study.


Assuntos
Tratamento de Emergência/normas , Parada Cardíaca/terapia , Equipe de Respostas Rápidas de Hospitais/normas , Unidades de Terapia Intensiva/normas , Assistência Noturna/normas , Hospitalização/estatística & dados numéricos , Humanos , Avaliação de Resultados em Cuidados de Saúde
15.
Acta Anaesthesiol Scand ; 63(2): 215-221, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30125348

RESUMO

PURPOSE: The purpose of this study was to examine the prevalence of deviating vital parameters in general ward patients using rapid response team (RRT) criteria and National Early Warning Score (NEWS), assess exam duration, correct calculation and classification of risk score as well as mortality and adverse events. METHODS: Point prevalence study of vital parameters according to NEWS and RRT criteria of all adult patients admitted to general wards at a Scandinavian university hospital with a mature RRT. PRIMARY OUTCOME: prevalence of at-risk patients fulfilling at least one RRT criteria, total NEWS of 7 or greater or a single NEWS parameter of 3 (red NEWS). SECONDARY OUTCOMES: mortality in-hospital and within 30 days or adverse events within 24 hours. RESULTS: We assessed 598 (75%) of 798 admitted patients and examiners captured a fulfilled RRT calling criterion in 50 patients (8.4%), 36 (6.0%) had NEWS ≥ 7, 34 with a red NEWS parameter. Red NEWS occurred in 112 patients (18.7%). Secondary outcomes were fulfilled in 49 patients (8.2%). Mortality overall was 6.5% within 30 days, 1.8% in hospital. In 134 patients (22.4%) the manual calculation of score for NEWS was incorrectly performed by examiner. CONCLUSION: Even with a mature RRT in place, we captured patients with failing physiology in general wards reflecting afferent limb failure. Manual calculation of NEWS is frequently incorrect, possibly leading to misclassification of patients at risk.


Assuntos
Escore de Alerta Precoce , Equipe de Respostas Rápidas de Hospitais/normas , Idoso , Comorbidade , Estudos Transversais , Erros de Diagnóstico , Diagnóstico Precoce , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/mortalidade , Mortalidade Hospitalar , Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Medição de Risco , Países Escandinavos e Nórdicos/epidemiologia , Resultado do Tratamento , Sinais Vitais
16.
Intensive Crit Care Nurs ; 51: 20-26, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30579825

RESUMO

BACKGROUND: Patient and/or family activated escalation may improve care to deteriorating patients. However, limited literature describes patients' and families' experience of deterioration and what barriers might restrict call activation. OBJECTIVE: This study explored patients' and families' experiences of acute ward deterioration, their perception of a need for a patient and/or family activated escalation service and barriers that may prevent them from using it. DESIGN: Using a qualitative cross sectional research design and a co-design approach, data were collected using face-to-face semi-structured interviews, field notes and reflective journaling. Between December 2015 and February 2016, purposeful sampling recruited 41 adult ward patients and family who either experienced a recent Medical Emergency team (MET) or Patient at Risk team (PART) escalation, or no recent MET or PART escalation. FINDINGS: Themes included: (1) patient awareness of their illness and deterioration, 2) the importance of returning to their normal lives, (3) reassurance on arrival of the PART and MET, (4) beliefs held to prevent use of such a service, and (5) support for a patient and/or family activated escalation service. CONCLUSION: Most participants supported a patient and/or family activated escalation service, however barriers may prevent some patients from using it.


Assuntos
Equipe de Respostas Rápidas de Hospitais/normas , Satisfação do Paciente , Pacientes/psicologia , Percepção , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Fatores de Tempo
17.
J Patient Saf ; 15(3): 173-180, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-28872476

RESUMO

INTRODUCTION: Intravenous medication errors (MEs) occur during medical emergency situations. An initiative, not yet in common practice, that could address these errors is safety labeling. The aim of this review was to identify and appraise research evidence related to the impact of user-applied medication safety labeling on reducing the incidence of MEs during rapid medical response intervention for patient deterioration in the ward setting. METHODS: A systematic search and review framework was used to conduct the review. A comprehensive database search was conducted of BioMed Central, Clinical Trials, Cumulative Index to Nursing and Allied Health Literature, Expanded Academic ASAP, Joanna Briggs Institute, MEDLINE, OVID, ProQuest Central, PubMed, Wiley Online Library, and World Health Organization Library. The Young and Solomon (2009) critical appraisal tool was used to critically appraise the identified research articles. Each article was then analyzed using a thematic network strategy to identify commonality. RESULTS: Four primary themes were identified; they were as follows: MEs occur during medical emergency responses (MERs); MEs occur throughout the medication administration process; MERs are stressful and are associated with MEs; and role of medication labeling in reducing MEs during MERs. DISCUSSION: Greater vigilance is required by health professionals during the medication administration process. The implementation of specific medication safety labeling into the MER could be beneficial in reducing the overall incidence of MEs. Further research is required to validate the merits of a MER medication safety labeling system.


Assuntos
Administração Intravenosa/métodos , Equipe de Respostas Rápidas de Hospitais/normas , Seringas/provisão & distribução , Assistência à Saúde , Humanos , Incidência , Erros de Medicação
18.
BMJ Qual Saf ; 28(4): 327-337, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30309910

RESUMO

BACKGROUND: Educational interventions to improve teamwork in crisis situations have proliferated in recent years with substantial variation in teamwork measurement. This systematic review aimed to synthesise available tools and their measurement properties in order to identify the most robust tool for measuring the teamwork performance of teams in crisis situations. METHODS: Searches were conducted in Embase (via OVID), PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Medline and Medline In-Process (via OVID) (through 12 January 2017). Studies evaluating the measurement properties of teamwork assessment tools for teams in clinical or simulated crisis situations were included. Two independent reviewers screened studies based on predetermined criteria and completed data extraction. Risk of bias was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. RESULTS: The search yielded 1822 references. Twenty studies were included, representing 13 assessment tools. Tools were primarily assessed in simulated resuscitation scenarios for emergency department teams. The Team Emergency Assessment Measure (TEAM) had the most validation studies (n=5), which demonstrated three sources of validity (content, construct and concurrent) and three sources of reliability (internal consistency, inter-rater reliability and test-retest reliability). Most studies of TEAM's measurement properties were at no risk of bias. CONCLUSIONS: A number of tools are available for assessing teamwork performance of teams in crisis situations. Although selection will ultimately depend on the user's context, TEAM may be the most promising tool given its measurement evidence. Currently, there is a lack of tools to assess teamwork performance during intraoperative crisis situations. Additional research is needed in this regard.


Assuntos
Competência Clínica/normas , Assistência à Saúde/normas , Emergências , Equipe de Respostas Rápidas de Hospitais/normas , Equipe de Assistência ao Paciente/normas , Análise e Desempenho de Tarefas , Humanos , Reprodutibilidade dos Testes
19.
Crit Care ; 22(1): 227, 2018 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-30241490

RESUMO

BACKGROUND: Frailty is a state of vulnerability to poor resolution of homeostasis after a stressor event and is strongly associated with adverse outcomes. Therefore, the assessment of frailty may be an essential part of evaluation in any healthcare encounter that might result in an escalation of care. The purpose of the study was to assess the frequency and association of frailty with clinical outcomes in patients subject to rapid response team (RRT) review. METHODS: In this multi-national prospective observational cohort study, centres with existing RRTs collected data over a 7-day period, with follow up of all patients at 24 h following their RRT call and at hospital discharge or 30 days following the event trigger (whichever came sooner). Investigators also collected data on the triggers and interventions provided and a bedside assessment on the level of patients' frailty using a clinical frailty scale. RESULTS: Amongst 1133 patients, 40% were screened as frail, which was associated with older age (p < 0.001), admission under a medical speciality (p < 0.001), increased severity of illness at the time of the RRT review (p = 0.0047), and substantially higher frequency of limitations of care (p < 0.001). Importantly, 72% of patients screened as frail were either dead or dependent on hospital care by 30 days (p < 0.001). In the multivariable analysis, the significant risk factors for the composite endpoint "poor recovery" (died or were hospital-dependent by 30 days) were age (odds ratio (OR), 1.04; 95% confidence interval (CI), 1.03-1.05; p < 0.001), frailty level (p < 0.001), existing limitation of care (OR, 2.0; 95% CI, 1.3-3.0; p < 0.001), and the quick sequential organ failure assessment (qSOFA) score (p < 0.001). CONCLUSIONS: Higher frailty scores were associated with increased mortality and dependence on health care at 30 days. Our results indicate that frailty has an influence on the clinical trajectory of deteriorating patients and that such assessment should be included in discussion of goals and expectations of care. TRIAL REGISTRATION: Netherlands Trial Registry, NTR5535 . Registered on 23 December 2015.


Assuntos
Fragilidade/complicações , Equipe de Respostas Rápidas de Hospitais/normas , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Estudos de Coortes , Feminino , Fragilidade/mortalidade , Mortalidade Hospitalar , Equipe de Respostas Rápidas de Hospitais/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Internacionalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Projetos de Pesquisa/estatística & dados numéricos
20.
Invest Educ Enferm ; 36(2)2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-30148939

RESUMO

OBJECTIVES: Describe the knowledge in the literature related to factors that influence the performance of response teams. METHODS: Integrative review of the literature of articles published in Portuguese, English or Spanish between 2006 and 2016. The descriptors hospital rapid response equipment, cardiac arrest and hospital mortality were used for the search in the PubMed/Medline, Lilacs - Bireme and CINAHL bibliographic databases. RESULTS: 19 studies were included for the analysis. The results were categorized in: sociocultural barriers and institutional policies, late activation of the rapid response team, composition and/or strengthening of the team's capacity, and use of facilitating tools. The sociocultural barriers found were: the presence of interprofessional hierarchies and beliefs, the limitations of institutional policies were related to the lack of training and human resources deficit. Late activations increased mortality, duration of hospitalization, and admission to the intensive care unit. The teams composed of intensive care professionals showed a reduction in mortality and in the occurrence of cardiac arrest. The use of new tools did not promote changes in the response of the team. CONCLUSIONS: The factors found in this review influence the performance of the rapid response team. The foregoing should be taken into account to improve the survival of patients who require this type of care.


Assuntos
Competência Clínica , Parada Cardíaca/terapia , Equipe de Respostas Rápidas de Hospitais/organização & administração , Mortalidade Hospitalar , Equipe de Respostas Rápidas de Hospitais/normas , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação
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