本邦で院内救急体制（RRS）を普及する際の障壁とその解決策(The implementation of rapid response system in Japanese hospitals: its obstacles and possible solutions)

要旨 【目的】本邦でRRS（rapid response system）を導入するには様々な障壁がある。RRS普及を目的とした医療安全講習会で受講者にアンケートを実施し，この障壁を明らかにする。【対象】アンケートでCode blueとRRSの認知度，予期せぬ死亡の経験，心停止前に対応するチームの必要性，RRS導入の障壁となるコンポーネント（構成要素），具体的問題を問い，回答（回収1,391，有効回答1,242）を集計した。【結果】Code blueに対しRRSの認知度は低く，とくに医師・看護師以外で低かった。予期せぬ死亡は86.2%が経験しており，心停止前に対応するチームの必要性は91.6%が感じていたが，うち86.2%は導入に障壁を感じていた。障壁と考えるコンポーネントは患者の状態悪化を発見する要素が67.0%，急変対応チームの要素が49.8%と多く，具体的問題では急変対応チーム医師不足62.6%，同看護師不足59.7%，RRSを主導する医師・管理部門サポート不足46.5%，システム教育プログラム不備39.6%，主治医協力不足34.1%であった。【結語】医師・看護師のマンパワー不足，教育システムの不備を障壁と考える医療従事者が多かった。人員不足の改善，RRS起動・急変対応チーム活動を教育するシステムの整備がRRS導入に必要と考えられた。 ABSTRACT Objectives: The implementation of rapid response system (RRS) faces several challenges in Japan. A specifically designed survey was conducted at medical centers during the required mandatory medical risk management seminars in order to elucidate possible hindrances. Subjects: The survey investigated the degree of awareness of ‘Code blue’ vs. RRS, exposure to unexpected patient deaths, pre–cardiac arrest response requirements, potential obstacles when implementing all 4 RRS components (afferent, efferent, process improvement and administrative) as well as other obvious hindrances. Out of 1,391 surveys distributed, we analyzed 1,242 responded surveys. Results: The physician–nurse community recognized the RRS (36.8%) considerably less than Code blue (75.1%) and was further less recognized by other healthcare professionals (24.4%). Of all the healthcare professionals, 86.2% demonstrated an overall experience with unexpected death and expressed the importance to introduce RRS to critically ill patients. However among them, 86.2% admitted that introducing RRS might be difficult. The probable causes hindering RRS introduction were the afferent (factors for prompt identification of patient deterioration) and efferent (medical emergency team activation: MET) components with 67.0% and 49.8% respectively followed by the lack of RRS team physicians (62.6%), lack of RRS team nurses (59.7%), non–designated leading physicians, insufficient administrative support (46.5%), insufficient RRS teaching programs (39.6%) and reticent physician support (34.1%). Conclusion: The lack of physicians, nurses, awareness and training programs are a hindrance to the successful implementation of RRS. Further RRS and MET awareness programs might help for a better RRS integration.