Objective: 

To reduce the frequency of non-ICU arrests through the implementation of an intramural collaborative focused on patient deterioration.

Design: 

Prospective quality improvement project.

Setting: 

Single-center, free-standing, tertiary children’s hospital.

Patients: 

All patients admitted to acute care units.

Interventions: 

The Late Rescue Collaborative was formed in 2014 to monitor compliance with hospital escalation protocols and evaluate episodes of patient deterioration. The collaborative is a multidisciplinary team of physicians, nurses, and respiratory care providers. Three monthly meetings occur: 1) individual acute care unit–based meetings to evaluate trends and performance; 2) hospital-wide multidisciplinary whole group meetings to review hospital trends in deterioration and share lessons learned; and 3) steering committee to determine areas of focus. Based on these three meetings, unit- and hospital-based interventions have been put in place to improve recognition of deterioration and promote early rescue.

Measurements and Main Results: 

Rates of rapid response team activations, unplanned transfers, and non-ICU arrest are reported. Non-ICU arrest rates fell from a baseline of 0.31 per 1,000 non-ICU patient days to a new centerline of 0.11 and sustained for 36 months. Days between non-ICU arrests increased from a baseline of 15.5 days in year 2014 to a new centerline of 61.5 days and sustained for 37 months. Mortality following non-ICU arrests fell from four in 2014 and 2015 to zero in years 2016–2018.

Conclusion: 

The Late Rescue Collaborative is an effective tool to improve patient safety by reducing non-ICU arrests.

中文翻译：

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后期救援协作：减少非ICU逮捕。

目的： 

通过实施针对患者恶化的壁内协作来减少非ICU逮捕的频率。

设计： 

预期的质量改进项目。

设置： 

单中心，独立式三级儿童医院。

耐心： 

所有患者均入急诊病房。

干预措施： 

2014年成立了后期救援合作组织，以监督医院升级协议的执行情况并评估患者病情恶化的情况。该协作小组是由医生，护士和呼吸保健提供者组成的多学科团队。每三个月召开一次会议：1）基于个人急诊科的会议，以评估趋势和绩效；2）在医院范围内的多学科全组会议，以审查医院恶化的趋势并分享经验教训；3）指导委员会确定重点领域。在这三次会议的基础上，已经采取了基于单位和医院的干预措施，以改善对恶化的认识并促进早期抢救。

测量和主要结果： 

报告了快速反应团队激活，计划外转移和非ICU逮捕的发生率。非ICU逮捕率从每1,000非ICU患者日0.31的基线下降到0.11的新中心线，并持续了36个月。非ICU逮捕之间的间隔时间从2014年的15.5天增加到61.5天的新中心线，并持续了37个月。非ICU被捕后的死亡率从2014年和2015年的四人下降到2016-2018年的零。

结论： 

后期救援协作组织是通过减少非ICU逮捕来提高患者安全性的有效工具。