{"title":"整合快速反应小组和早期预警系统以减少心脏骤停和重症监护病房再入院。","authors":"Laura Weigand, Tracy Viers, Eydie Tipton","doi":"10.4037/ccn2025131","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Early identification and treatment of clinical deterioration is crucial for improving outcomes among hospital patients. A high-acuity response team (HART) program can integrate early warning systems and proactive rounding by critical care nurses to prevent unplanned escalations in care.</p><p><strong>Local problem: </strong>During the COVID-19 pandemic, a HART program was inconsistently implemented because of intensive care unit staffing shortages. Barriers to optimizing the HART nurse role included inconsistent practices, lack of clear role expectations, and frequent reassignment of HART nurses to compensate for staffing shortages.</p><p><strong>Methods: </strong>Postpilot implementation of the HART program began in October 2019. Critical care nurses were designated as HART nurses, responsible for monitoring the Rothman Index, and assisted bedside nurses with high-acuity patients. Data were collected from 2019 to 2023 and were analyzed using IBM SPSS Statistics, version 29, with statistical significance defined as P ≤ .05.</p><p><strong>Results: </strong>The HART program significantly reduced 24-hour intensive care unit readmissions by 33.9% and 72-hour readmissions by 32.7%. HART nurse consultations increased by 35.7%. There were clinically significant decreases in code blue emergencies outside the intensive care unit (22.2%) and overall (16.7%), although no statistically significant differences were found for rapid response team activations or unplanned intensive care unit transfers.</p><p><strong>Conclusion: </strong>The HART nurse program effectively integrates early warning systems and rapid response teams, significantly reducing intensive care unit readmissions and improving patient care. Clear role expectations and dedicated staffing are needed, and continuous stakeholder engagement and resource allocation are essential for sustaining the program's success.</p>","PeriodicalId":10738,"journal":{"name":"Critical care nurse","volume":"45 4","pages":"49-56"},"PeriodicalIF":2.0000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Integration of Rapid Response Teams and Early Warning Systems to Reduce Cardiac Arrests and Intensive Care Unit Readmissions.\",\"authors\":\"Laura Weigand, Tracy Viers, Eydie Tipton\",\"doi\":\"10.4037/ccn2025131\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Early identification and treatment of clinical deterioration is crucial for improving outcomes among hospital patients. A high-acuity response team (HART) program can integrate early warning systems and proactive rounding by critical care nurses to prevent unplanned escalations in care.</p><p><strong>Local problem: </strong>During the COVID-19 pandemic, a HART program was inconsistently implemented because of intensive care unit staffing shortages. Barriers to optimizing the HART nurse role included inconsistent practices, lack of clear role expectations, and frequent reassignment of HART nurses to compensate for staffing shortages.</p><p><strong>Methods: </strong>Postpilot implementation of the HART program began in October 2019. Critical care nurses were designated as HART nurses, responsible for monitoring the Rothman Index, and assisted bedside nurses with high-acuity patients. Data were collected from 2019 to 2023 and were analyzed using IBM SPSS Statistics, version 29, with statistical significance defined as P ≤ .05.</p><p><strong>Results: </strong>The HART program significantly reduced 24-hour intensive care unit readmissions by 33.9% and 72-hour readmissions by 32.7%. HART nurse consultations increased by 35.7%. There were clinically significant decreases in code blue emergencies outside the intensive care unit (22.2%) and overall (16.7%), although no statistically significant differences were found for rapid response team activations or unplanned intensive care unit transfers.</p><p><strong>Conclusion: </strong>The HART nurse program effectively integrates early warning systems and rapid response teams, significantly reducing intensive care unit readmissions and improving patient care. Clear role expectations and dedicated staffing are needed, and continuous stakeholder engagement and resource allocation are essential for sustaining the program's success.</p>\",\"PeriodicalId\":10738,\"journal\":{\"name\":\"Critical care nurse\",\"volume\":\"45 4\",\"pages\":\"49-56\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical care nurse\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4037/ccn2025131\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical care nurse","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4037/ccn2025131","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景:早期识别和治疗临床恶化对改善住院患者的预后至关重要。一个高灵敏度反应小组(HART)项目可以整合早期预警系统和重症监护护士的主动查房,以防止意外的护理升级。当地问题:在2019冠状病毒病大流行期间,由于重症监护室人员短缺,HART计划的实施不一致。优化HART护士角色的障碍包括不一致的实践,缺乏明确的角色期望,以及HART护士经常重新分配以弥补人员短缺。方法:自2019年10月开始实施HART计划。指定重症监护护士为HART护士,负责监测Rothman指数,协助床边护士护理高敏度患者。数据收集于2019 - 2023年,使用IBM SPSS Statistics, version 29进行分析,统计学意义定义为P≤0.05。结果:HART方案显著降低了24小时重症监护室再入院率33.9%和72小时再入院率32.7%。HART护士咨询增加了35.7%。重症监护病房外的蓝色代码紧急情况(22.2%)和总体(16.7%)的临床显著下降,尽管快速反应小组的激活或计划外的重症监护病房转移没有统计学上的显著差异。结论:HART护士项目有效地整合了早期预警系统和快速反应团队,显著减少了重症监护室再入院率,改善了患者护理。需要明确的角色期望和专门的人员配备,并且持续的涉众参与和资源分配对于维持项目的成功至关重要。
Integration of Rapid Response Teams and Early Warning Systems to Reduce Cardiac Arrests and Intensive Care Unit Readmissions.
Background: Early identification and treatment of clinical deterioration is crucial for improving outcomes among hospital patients. A high-acuity response team (HART) program can integrate early warning systems and proactive rounding by critical care nurses to prevent unplanned escalations in care.
Local problem: During the COVID-19 pandemic, a HART program was inconsistently implemented because of intensive care unit staffing shortages. Barriers to optimizing the HART nurse role included inconsistent practices, lack of clear role expectations, and frequent reassignment of HART nurses to compensate for staffing shortages.
Methods: Postpilot implementation of the HART program began in October 2019. Critical care nurses were designated as HART nurses, responsible for monitoring the Rothman Index, and assisted bedside nurses with high-acuity patients. Data were collected from 2019 to 2023 and were analyzed using IBM SPSS Statistics, version 29, with statistical significance defined as P ≤ .05.
Results: The HART program significantly reduced 24-hour intensive care unit readmissions by 33.9% and 72-hour readmissions by 32.7%. HART nurse consultations increased by 35.7%. There were clinically significant decreases in code blue emergencies outside the intensive care unit (22.2%) and overall (16.7%), although no statistically significant differences were found for rapid response team activations or unplanned intensive care unit transfers.
Conclusion: The HART nurse program effectively integrates early warning systems and rapid response teams, significantly reducing intensive care unit readmissions and improving patient care. Clear role expectations and dedicated staffing are needed, and continuous stakeholder engagement and resource allocation are essential for sustaining the program's success.
期刊介绍:
Critical Care Nurse (CCN) is an official publication of the American Association of Critical-Care Nurses (AACN). Authors are invited to submit manuscripts for consideration and peer review. Clinical topics must meet the mission of CCN and address nursing practice of acute and critically ill patients.