Implementation of a rapid response team in a large nonprofit Brazilian hospital: improving the quality of emergency care through Plan-Do-Study-Act.

Autor: Almeida MC; Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil., Portela MC; Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brasil., Paiva EP; Faculdade de Enfermagem, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brasil., Guimarães RR; Faculdade de Enfermagem, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brasil., Pereira Neto WC; Santa Casa de Misericórdia de Juiz de Fora - Juiz de Fora (MG), Brasil., Cardoso PR; Santa Casa de Misericórdia de Juiz de Fora - Juiz de Fora (MG), Brasil., Mattos DA; Santa Casa de Misericórdia de Juiz de Fora - Juiz de Fora (MG), Brasil., Mendes IMACC; Santa Casa de Misericórdia de Juiz de Fora - Juiz de Fora (MG), Brasil., Tavares MV; Santa Casa de Misericórdia de Juiz de Fora - Juiz de Fora (MG), Brasil., Jácome GPO; Santa Casa de Misericórdia de Juiz de Fora - Juiz de Fora (MG), Brasil., Fernandes GC; Santa Casa de Misericórdia de Juiz de Fora - Juiz de Fora (MG), Brasil.
Jazyk: Portuguese; English
Zdroj: Revista Brasileira de terapia intensiva [Rev Bras Ter Intensiva] 2019 Jun 10; Vol. 31 (2), pp. 217-226. Date of Electronic Publication: 2019 Jun 10.
DOI: 10.5935/0103-507X.20190036
Abstrakt: Objective: To describe the implementation of a rapid response team in a large nonprofit hospital, indicating relevant issues for other initiatives in similar contexts, particularly in Latin America.
Methods: In general terms, the intervention consisted of three major components: (1) a tool to detect aggravation of clinical conditions in general wards; (2) the structuring of a rapid response team to attend to all patients at risk; and (3) the monitoring of indicators regarding the intervention. This work employed four half-year Plan-Do-Study-Act cycles to test and adjust the intervention from January 2013 to December 2014.
Results: Between 2013 and 2014, the rapid response team attended to 2,296 patients. This study showed a nonsignificant reduction in mortality from 8.3% in cycle 1 to 5.0% in cycle 4; however, death rates remained stable in cycles 3 and 4, with frequencies of 5.2% and 5.0%, respectively. Regarding patient flow and continuum of critical care, which is a premise of the rapid response system, there was a reduction in waiting time for intensive care unit beds with a decrease from 45.9% to 19.0% in the frequency of inpatients who could not be admitted immediately after indication (p < 0.001), representing improved patient flow in the hospital. In addition, an increase in the recognition of palliative care patients from 2.8% to 10.3% was noted (p = 0.005).
Conclusion: Implementing a rapid response team in contexts where there are structural restrictions, such as lack of intensive care unit beds, may be very beneficial, but a strategy of adjustment is needed.
Databáze: MEDLINE
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