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Aktuelle Konzepte der Patientensicherheit

Das „Rapid-response“-System

Current concepts of patient safety

Rapid response system

  • Berufspolitisches Forum
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Zusammenfassung

Die „Kampagne für 100.000 Patientenleben“ hat in den USA zur Proklamation so genannter „Rapid-response“-Teams geführt. Diese definierten Notfallteams sind rund um die Uhr verfügbar und werden bei einer akuten physiologischen Verschlechterung stationärer Patienten anhand definierter Parameter alarmiert. Ein standardisiertes „Rapid-response“-System (RRS) soll vermeiden, dass Patienten im Rahmen einer verzögert erkannten akuten klinischen Verschlechterung im Krankenhaus versterben. Prospektive Studien aus den USA und Australien haben gezeigt, dass die Implementierung und die kontinuierliche Optimierung eines teambasierten RRS zu einer signifikanten Reduktion kardiopulmonaler Reanimationen und Patientensterblichkeit führen. Als Alternative zu den „Rapid-response“-Teams wurde kürzlich ein neues System der triggerinduzierten „Rapid-response“-Eskalation definiert und in Pilotstudien erfolgreich umgesetzt. Die vorliegende Übersicht präsentiert das generelle Konzept des RRS mit einem Fokus auf die spezifischen Vor- und Nachteile der teambasierten vs. triggergestützten Modalität. Die Einführung standardisierter „Rapid-response“-Systeme sollte auch in Deutschland geprüft werden, um die Patientensicherheit zu erhöhen und eine Reduktion der vermeidbaren Patientensterblichkeit herbeizuführen.

Abstract

The “100,000 lives campaign” initiated a wide-spread implementation of rapid response teams in the United States. A standardized rapid response system (RRS) is designed to reduce the preventable mortality of hospitalized patients who frequently have progressive signs of physiological deterioration minutes to hours before cardiac arrest. The implementation and maturation of a team-based RRS has been shown to significantly reduce the incidence of “COR zero” calls and, in some studies, the in-hospital mortality rate. An alternative model to rapid response teams has been recently proposed which is based on defined clinical triggers to initiate a “rapid response escalation”. This clinical triggers program overcomes the classic limitations of a team-based system, such as the overuse of resources and the fragmentation of patient care. The present review outlines the basic RRS concept with a focus on the debate related to the “perfect” patient safety system, namely the validity of a distinct rapid response teams approach versus a trigger-based escalation modality. The implementation of a standardized RRS should also be considered in German hospitals with the aim of improving patient safety and reducing preventable in-hospital mortality.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Department of Neurosurgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, 80204, Denver, CO, USA

    P.F. Stahel & M.A. Flierl

  2. Department of Neurosurgery , University of Colorado, School of Medicine, Denver, CO, USA

    P.F. Stahel

  3. Department of Orthopaedics, Waldkrankenhaus Bad Düben, Bad Düben, Deutschland

    J.K.M. Fakler

  4. Department of Patient Safety and Quality, Denver Health Medical Center, Denver, CO, USA

    K. Moldenhauer & P.S. Mehler

  5. Department of Internal Medicine, Denver Health Medical Center, University of Colorado, School of Medicine, Denver, CO, USA

    P.S. Mehler

Authors
  1. P.F. Stahel
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  2. J.K.M. Fakler
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  3. M.A. Flierl
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  4. K. Moldenhauer
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  5. P.S. Mehler
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Corresponding author

Correspondence to P.F. Stahel.

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Stahel, P., Fakler, J., Flierl, M. et al. Aktuelle Konzepte der Patientensicherheit. Unfallchirurg 113, 239–246 (2010). https://doi.org/10.1007/s00113-009-1734-7

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  • DOI: https://doi.org/10.1007/s00113-009-1734-7

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