National Survey: How Do We Approach the Patient at Risk of Clinical Deterioration outside the ICU in the Spanish Context?
Abstract
:1. Introduction
Aim
2. Materials and Methods
2.1. Research Design
2.2. Inclusion and Exclusion Criteria
2.3. Instruments
2.4. Procedure
2.5. Variables
2.5.1. Socio-Demographic Variables
2.5.2. Afferent Limb
2.5.3. Efferent Limb
2.5.4. Administrative Limb
2.5.5. Quality Improvement Limb
2.6. Statistical Analysis
3. Results
3.1. Introduction: Demographics and RRS
3.2. The Afferent Limb: How the Risk of Deterioration Is Detected, and the System Activated
3.3. The Efferent Limb: Once Risk Is Detected, How the System Reponds to It
3.4. The Administrative Limb: Provides Human, Educational, and Material Resources to the System
3.4.1. Educational Resources
3.4.2. Material Resources
3.5. The Quality Improvement Limb: How the System Measures Its Interventions and Provides Feedback to Itself and the Rest of the Organization
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Frequency on Measuring Vital Signs | N | % |
---|---|---|
Once every shift, contemplating other frequencies | 30 | 48.4 |
Once per-shift only | 27 | 43.5 |
As per nurse criteria | 4 | 6.5 |
As per doctor criteria | 1 | 1.6 |
Vital signs measured | N | % |
Respiratory rate | 31 | 50 |
Fraction of Inspired Oxygen (FiO2) | 26 | 41.9 |
Oxygen Saturation (SpO2) | 42 | 67.7 |
Heart rate | 47 | 75.8 |
Systolic blood pressure | 62 | 100 |
Temperature | 62 | 100 |
Level of consciousness | 27 | 43.5 |
Urine output | 1 | 1.6 |
Vital signs registration | N | % |
Registered in paper, then manually into electronic records | 41 | 66.1 |
Automated from bedside to electronic records | 17 | 27.4 |
Paper, no electronic records | 4 | 6.5 |
Discriminating abnormality | N | % |
None–professional criteria | 43 | 69.4 |
Standardized scores to interpret and respond | 12 | 19.4 |
Guidelines and/or protocols | 7 | 11.3 |
Automated alarms on abnormal parameters | N | % |
None | 41 | 66.1 |
Vital signs | 12 | 19.4 |
Laboratory-blood tests | 12 | 19.4 |
Laboratory-Microbiology | 9 | 14.5 |
Radiology | 0 | 0 |
Professional Able to Activate RRT | N | % |
---|---|---|
All professionals (including, HealthCare Assistants, Physiotherapist, etc.) | 24 | 39 |
Only doctors and nurses | 34 | 55 |
Nurses, only if responsible doctor not available | 3 | 5 |
Only doctors | 1 | 1.6 |
Method for activating RRT | N | % |
Automated alarm directly to RRT | 0 | 0 |
Emergency button at bedside | 3 | 4.8 |
Telephone call–Unidirectional–No direct communication with RRT | 17 | 27.4 |
Telephone call–Bidirectional–direct communication with RRT | 50 | 80.6 |
Automated alarm directly to RRT | 0 | 0 |
Moment of activation | N | % |
Risk and/or early signs of clinical deterioration | 7 | 11.3 |
Established signs of instability | 50 | 80.6 |
Moments prior to cardiac arrest | 49 | 79 |
Established cardiac arrest | 50 | 80.6 |
Changes in vital signs | 53 | 85.5 |
Signs of clinical deterioration | 51 | 82.3 |
Concern from the responsible professional | 35 | 56.5 |
Syndromic presentation | 25 | 40.3 |
Laboratory/blood test abnormalities | 23 | 37.1 |
Blood test abnormalities without changes in vital signs | 17 | 27.4 |
Changes in vital signs | 53 | 85.5 |
RRT Most Common Responders | N | % |
Only on call physician–intensivist | 17 | 15% |
One RRT | 46 | 74% |
More than one RRT | 16 | 26% |
RRT Most Common Members | N | % |
Intensive Care Consultant | 59 | 95.2 |
Intensive Care Resident | 33 | 53.2 |
Intensive Care Nurse | 15 | 24.2 |
RRT full time dedicated Nurse | 2 | 3.2 |
Anesthesia Consultant | 9 | 14.5 |
Anesthesia Resident | 5 | 8.1 |
Emergency Department Consultant | 4 | 6.5 |
Emergency Department Nurse | 1 | 1.6 |
Cardiology Consultant | 3 | 4.8 |
Cardiology Resident | 3 | 4.8 |
General/Internal Medicine Consultant | 4 | 6.5 |
General/Internal Medicine resident | 4 | 6.5 |
Other specialties Consultants | 2 | 3.2 |
No Resident | 3 | 4.8 |
Nurse from other specialties | 2 | 3.2 |
No nurse | 8 | 12.9 |
Porter | 7 | 10.6 |
Healthcare Assistant | 2 | 3% |
Charge Nurse/Supervisor | 1 | 1.6 |
RRT Availability | N | % |
24/7 h | 57 | 91.1 |
Monday to Friday: 8–15 h or 8–17 h) | 3 | 4.8 |
Everyday 8–22 h | 1 | 1.6 |
Monday to Friday 8–20 h (10–17 h dedicated nurse) | 1 | 1.6 |
Team Leadership | N | % |
Preestablished | 57 | 92.8 |
Established in-situ | 5 | 7.2 |
Role distribution | 53 | 85.5 |
Preestablished | 42 | 67.7 |
Established in-situ | 20 | 32.3 |
Resuscitation Guidelines | N | % |
---|---|---|
ERC | 44 | 71 |
AHA | 3 | 4.8 |
ERC/AHA depending on unit | 7 | 11.3 |
ERC/AHA depending on Team Leader | 8 | 12.9 |
Ward nurses training | N | % |
No standardized training plan | 12 | 19.4 |
Who and how to call in an emergency | 25 | 40.3 |
Basic Life Support (BLS) | 34 | 54.8 |
Immediate Life Support (ILSI | 24 | 38.7 |
Advanced Life Support (ALS) | 24 | 38.7 |
RRT members training | N | % |
No standardized training plan | 11 | 17.7 |
Basic Life Support (BLS) | 14 | 22.6 |
Immediate Life Support (ILSI | 6 | 9.7 |
Advanced Life Support (ALS) | 26 | 41.9 |
Other Specific training/experience | 45 | 72.6 |
Simulation for training | 53 | 85.5 |
No simulation activities | 16 | 25.8 |
Some simulation activities | 32 | 51.6 |
Trained simulation instructors | 25 | 40.3 |
Dedicated space for sim training | 7 | 11.3 |
Dedicated center/unit and professionals’ team | 10 | 16.1 |
Depends on a University | 1 | 1.6 |
Opening a center in the next 1 year | 1 | 1.6 |
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Clemente Vivancos, Á.; León Castelao, E.; Castellanos Ortega, Á.; Bodi Saera, M.; Gordo Vidal, F.; Martin Delgado, M.C.; Jorge-Soto, C.; Fernandez Mendez, F.; Igeño Cano, J.C.; Trenado Alvarez, J.; et al. National Survey: How Do We Approach the Patient at Risk of Clinical Deterioration outside the ICU in the Spanish Context? Int. J. Environ. Res. Public Health 2022, 19, 12627. https://doi.org/10.3390/ijerph191912627
Clemente Vivancos Á, León Castelao E, Castellanos Ortega Á, Bodi Saera M, Gordo Vidal F, Martin Delgado MC, Jorge-Soto C, Fernandez Mendez F, Igeño Cano JC, Trenado Alvarez J, et al. National Survey: How Do We Approach the Patient at Risk of Clinical Deterioration outside the ICU in the Spanish Context? International Journal of Environmental Research and Public Health. 2022; 19(19):12627. https://doi.org/10.3390/ijerph191912627
Chicago/Turabian StyleClemente Vivancos, Álvaro, Esther León Castelao, Álvaro Castellanos Ortega, Maria Bodi Saera, Federico Gordo Vidal, Maria Cruz Martin Delgado, Cristina Jorge-Soto, Felipe Fernandez Mendez, Jose Carlos Igeño Cano, Josep Trenado Alvarez, and et al. 2022. "National Survey: How Do We Approach the Patient at Risk of Clinical Deterioration outside the ICU in the Spanish Context?" International Journal of Environmental Research and Public Health 19, no. 19: 12627. https://doi.org/10.3390/ijerph191912627