Shannan K Hamlin, Nicole M Fontenot, Steven J Hooker, Hsin-Mei Chen
{"title":"基于系统的身体评估:早期发现临床恶化和降低死亡率。","authors":"Shannan K Hamlin, Nicole M Fontenot, Steven J Hooker, Hsin-Mei Chen","doi":"10.4037/ajcc2023113","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite efforts to improve early detection of deterioration in a patient's condition, delays in activating the rapid response team remain common.</p><p><strong>Objectives: </strong>To evaluate delays in activating the rapid response team and the occurrence of serious adverse events before and after implementation of a quality improvement initiative aimed at nurses' performing systems-based physical assessments.</p><p><strong>Methods: </strong>A retrospective observational cohort design was used to evaluate all patients who had a rapid response team activation during the study period.</p><p><strong>Results: </strong>A total of 1080 patients were included in the analysis: 536 patients before the quality improvement initiative and 544 patients after the quality improvement initiative. The delay in activating the rapid response team decreased from 11.7 hours in the before group to 9.6 hours in the after group (P < .001). In the after group, fewer patients were transferred to the intensive care unit (36% vs 41%, P = .02) and those who were transferred had 3.58 times greater odds of death than those who stayed at the same level of care. The after group had a 44% reduction in the odds of mortality compared with the before group.</p><p><strong>Conclusions: </strong>When nurses focus on conducting a systems-based physical assessment early in their shift, delays in recognizing a patient's deteriorating condition are reduced, fewer patients are admitted to the intensive care unit, and mortality is significantly reduced.</p>","PeriodicalId":7607,"journal":{"name":"American Journal of Critical Care","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Systems-Based Physical Assessments: Earlier Detection of Clinical Deterioration and Reduced Mortality.\",\"authors\":\"Shannan K Hamlin, Nicole M Fontenot, Steven J Hooker, Hsin-Mei Chen\",\"doi\":\"10.4037/ajcc2023113\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite efforts to improve early detection of deterioration in a patient's condition, delays in activating the rapid response team remain common.</p><p><strong>Objectives: </strong>To evaluate delays in activating the rapid response team and the occurrence of serious adverse events before and after implementation of a quality improvement initiative aimed at nurses' performing systems-based physical assessments.</p><p><strong>Methods: </strong>A retrospective observational cohort design was used to evaluate all patients who had a rapid response team activation during the study period.</p><p><strong>Results: </strong>A total of 1080 patients were included in the analysis: 536 patients before the quality improvement initiative and 544 patients after the quality improvement initiative. The delay in activating the rapid response team decreased from 11.7 hours in the before group to 9.6 hours in the after group (P < .001). In the after group, fewer patients were transferred to the intensive care unit (36% vs 41%, P = .02) and those who were transferred had 3.58 times greater odds of death than those who stayed at the same level of care. The after group had a 44% reduction in the odds of mortality compared with the before group.</p><p><strong>Conclusions: </strong>When nurses focus on conducting a systems-based physical assessment early in their shift, delays in recognizing a patient's deteriorating condition are reduced, fewer patients are admitted to the intensive care unit, and mortality is significantly reduced.</p>\",\"PeriodicalId\":7607,\"journal\":{\"name\":\"American Journal of Critical Care\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2023-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Critical Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4037/ajcc2023113\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Critical Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4037/ajcc2023113","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Systems-Based Physical Assessments: Earlier Detection of Clinical Deterioration and Reduced Mortality.
Background: Despite efforts to improve early detection of deterioration in a patient's condition, delays in activating the rapid response team remain common.
Objectives: To evaluate delays in activating the rapid response team and the occurrence of serious adverse events before and after implementation of a quality improvement initiative aimed at nurses' performing systems-based physical assessments.
Methods: A retrospective observational cohort design was used to evaluate all patients who had a rapid response team activation during the study period.
Results: A total of 1080 patients were included in the analysis: 536 patients before the quality improvement initiative and 544 patients after the quality improvement initiative. The delay in activating the rapid response team decreased from 11.7 hours in the before group to 9.6 hours in the after group (P < .001). In the after group, fewer patients were transferred to the intensive care unit (36% vs 41%, P = .02) and those who were transferred had 3.58 times greater odds of death than those who stayed at the same level of care. The after group had a 44% reduction in the odds of mortality compared with the before group.
Conclusions: When nurses focus on conducting a systems-based physical assessment early in their shift, delays in recognizing a patient's deteriorating condition are reduced, fewer patients are admitted to the intensive care unit, and mortality is significantly reduced.
期刊介绍:
The editors of the American Journal of Critical Care
(AJCC) invite authors to submit original manuscripts
describing investigations, advances, or observations from
all specialties related to the care of critically and acutely ill
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