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Abstract(s)
As alterações dos sinais vitais predizem o risco de deterioração fisiológica. A sua deteção precoce permite a atuação atempada, o que pode prevenir a ocorrência de eventos adversos tais como morte, paragens cardiorrespiratórias ou transferência inesperada para a UCI.
Nas últimas décadas, têm sido desenvolvidos e implementados Sistemas de Resposta Rápida. Os Sistemas “Track and Trigger” correspondem ao seu ramo aferente, tendo como objetivo a deteção dos pacientes em deterioração aguda do seu estado de saúde ou em risco de deteriorar, e a ativação da resposta. Estes baseiam-se na monitorização e interpretação dos sinais vitais de acordo com determinados valores limite, utilizando um único ou um conjunto de parâmetros vitais e/ou scores.
Entre eles, destacam-se os Scores de Alerta Precoce, que são Sistemas “Track and Trigger” agregados e ponderados que consistem na atribuição ponderada de scores aos parâmetros vitais, de acordo com as alterações relativamente aos valores considerados normais, e ao somatório dos mesmos, definindo um score total. Apesar de não haver consenso, o National Early Warning Score parece ser o score com melhor desempenho.
Com base no score total, é possível ativar a resposta que pode consistir no aumento da frequência das monitorizações, na chamada de ajuda médica ou na ativação de Equipas de Resposta a Emergências. Estas equipas correspondem ao ramo eferente dos Sistemas de Resposta Rápida e são responsáveis pela resposta à deterioração clínica do paciente.
Apesar da utilização destes sistemas, o registo e aferição dos sinais vitais e a ativação do ramo eferente mantêm-se subótimos. O recurso a tecnologias, como por exemplo, Sistemas de Monitorização Integrada ou software como o VitalPAC®, tem a potencialidade de otimizar a utilização dos Sistemas de Resposta Rápida e, consequentemente melhorar o desfecho clínico dos pacientes.
A implementação eficaz de um Sistema de Resposta Rápida implica um processo de mudança organizacional, da cultura hospitalar e da dinâmica normal do hospital. A escolha de um Sistema “Track and Trigger” deve ir de encontro às necessidades do hospital e ter em conta a sua reprodutibilidade, precisão, aplicabilidade e a aceitabilidade por parte dos pacientes e também o tempo extra que a sua aplicação exige.
No futuro, é essencial mais investigação na área no sentido de aprimorar estas ferramentas e identificar os fatores que interferem na qualidade dos cuidados e que podem comprometer a segurança dos pacientes.
Changes in vital signs predict the risk of physiological deterioration. Early detection allows timely action, which can prevent the occurrence of adverse events such as death, cardiorespiratory arrest or unexpected transfer to UCI. In the last decades, Rapid Response Systems have been developed and implemented. The “Track and Trigger” Systems correspond to its afferent limb, with the purpose to detect acute deterioration of the patients’ health status or their risk to deteriorate, and to activate the response. These systems are based on interpretation and monitoring of vital signs according to certain limit values , using a single or multiple parameters and / or scores. Among them are the Early Warning Scores, which are aggregate weighted “Track and Trigger” Systems consisting in assigning scores to the weighted vital parameters, according to the changes relative to normal values, and the sum of these, defining a total score. Although there is no consensus, the National Early Warning Score seems to be the score with better performance. Based on total score, it is possible to activate the response that can consist in increasing frequency of monitoring, in calling medical help or activating of the Emergency Response Teams. These teams correspond to the efferent limb of Rapid Response Systems and are responsible for response to clinical deterioration of the patient. Despite the use of these systems, registration and measurement of vital signs and activation of efferent limb remain suboptimal. The use of technologies, such as Integrated Monitoring Systems or software such as VitalPAC ®, has the potential to optimize the use of Rapid Response Systems and consequently improve the clinical outcome of patients. Effective implementation of a Rapid Response System involves a process of organizational change, changes in the hospital culture and in the normal dynamics of the hospital. Choosing a “Track and Trigger” System should meet the needs of the hospital and consider its reproducibility, accuracy, applicability and acceptability to patients and the extra time that its application requires. In the future, it is essential to further research in the area in order to enhance these tools and to identify factors that affect the quality of care and may compromise patient safety.
Changes in vital signs predict the risk of physiological deterioration. Early detection allows timely action, which can prevent the occurrence of adverse events such as death, cardiorespiratory arrest or unexpected transfer to UCI. In the last decades, Rapid Response Systems have been developed and implemented. The “Track and Trigger” Systems correspond to its afferent limb, with the purpose to detect acute deterioration of the patients’ health status or their risk to deteriorate, and to activate the response. These systems are based on interpretation and monitoring of vital signs according to certain limit values , using a single or multiple parameters and / or scores. Among them are the Early Warning Scores, which are aggregate weighted “Track and Trigger” Systems consisting in assigning scores to the weighted vital parameters, according to the changes relative to normal values, and the sum of these, defining a total score. Although there is no consensus, the National Early Warning Score seems to be the score with better performance. Based on total score, it is possible to activate the response that can consist in increasing frequency of monitoring, in calling medical help or activating of the Emergency Response Teams. These teams correspond to the efferent limb of Rapid Response Systems and are responsible for response to clinical deterioration of the patient. Despite the use of these systems, registration and measurement of vital signs and activation of efferent limb remain suboptimal. The use of technologies, such as Integrated Monitoring Systems or software such as VitalPAC ®, has the potential to optimize the use of Rapid Response Systems and consequently improve the clinical outcome of patients. Effective implementation of a Rapid Response System involves a process of organizational change, changes in the hospital culture and in the normal dynamics of the hospital. Choosing a “Track and Trigger” System should meet the needs of the hospital and consider its reproducibility, accuracy, applicability and acceptability to patients and the extra time that its application requires. In the future, it is essential to further research in the area in order to enhance these tools and to identify factors that affect the quality of care and may compromise patient safety.
Description
Keywords
Deterioração Fisiológica Equipas de Resposta A Emergências Scores de Alerta Precoce Sistemas ?Track and Trigger? Sistemas de Resposta Rápida