目的 探讨神经外科快速反应小组（rapid response team,RRT）启动延迟的影响因素及改进策略。方法 回顾性分析杭州市某三级甲等医院2019年1月—2022年6月神经外科病区经RRT救治患者的临床资料,以RRT启动时间间隔是否超过15 min将其分为延迟组与非延迟组,比较两组临床指标的差异,分析启动延迟的影响因素。结果 共纳入145例患者,86例（59.3%）发生启动延迟。Logistic回归分析显示,年龄≥65岁、并发症≥2个、格拉斯哥昏迷评分量表评分<9分以及夜班时间段（17：01至次日07：59）是RRT启动延迟的独立危险因素（P<0.05）,而改良早期预警评分表评分≥7分为RRT启动延迟的保护性因素（P<0.05）。结论 临床工作中应加强对高龄、并发症多、病情危重及夜间患者的监测和病情观察,尽可能保证护理的连续性。建议在神经外科建立专科化的预警系统,医院层面要做好监控及分析,通过多元化途径对护士进行相关培训,帮助其合理启动快速反应系统。
Objective To explore the influencing factors and countermeasures of delayed rapid response team （RRT）activation in the Department of Neurosurgery. Methods We retrospectively analyzed the data of hospitalized patients treated with RRT from the Department of Neurosurgery in a tertiary class A hospital in Hangzhou,Zhejiang Province from January 2019 to June 2022. The patients were divided into two groups（delayed and non-delayed）according to whether the call duration was longer than 15 minutes. We compared the differences in clinical indicators between the two groups and analyzed influencing factors of delayed RRT activation. Results A total of 86 patients（59.3%）were found to experience delayed RRT activation among 145 included patients. Logistic regres-sion analysis showed that aged 65 and over,having more than two comorbidities,a score of GCS less than 9,and night duty（17:01—07:59）were independent risk factors for delayed RRT activation（P<0.05）. A score of MEWS（Modified Early Warning Score）more than 7 was an independent protective factor（P<0.05）. Conclusion Nurses should pay attention to aged or critically ill patients,patients with multiple comorbidities or nursed during night duty and ensure the continuity of care. It is suggested to establish a specialized early warning system for neurosurgery patients. The hospitals should strengthen monitoring and data analysis and provide training for nurses through diversified ways to help them summon the rapid response system effectively.
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