Developing and pilot testing quality indicators in the intensive care unit
Developing and pilot testing quality indicators in the intensive care unit
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DOI：
10.1016/j.jcrc.2003.08.003
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发表时间：
2003-09-01
影响因子：
3.7
通讯作者：
Dorman, T
中科院分区：
文献类型：
--
作者：
Pronovost, PJ;Berenholtz, SM;Dorman, T
目的：制定和实施一套有效的和可靠的，但实际的措施重症监护病房（ICU）的护理质量在一个队列的ICU和估计，根据目前的表现，潜在的机会，以提高quality.Methods：我们包括13个成人内科和外科ICU在城市社区教学和社区医院。为了监测先前确定的质量措施的性能，我们开发了3种数据收集工具：团队负责人、每日舍入和感染控制表。这些工具在实施前经过了试点测试、验证和修改。我们使用已发表的疗效估计，以估计我们目前的性能为每个过程的措施：适当的镇静，预防呼吸机相关性肺炎，适当的消化性溃疡病（PUD）的预防，适当的深静脉血栓形成（DVT）的预防，并适当使用输血的临床和经济效果。通气患者接受治疗的天数百分比中位数为：适当镇静64%，抬高床头67%，PUD预防89%，DVT预防87%。适当输血的中位率为33%。未能使用这些疗法可能会导致过多的发病率，死亡率和ICU的stay.Conclusion：为了提高护理质量，我们必须衡量我们的表现。这项试点研究表明，它是可行的，以实施一系列广泛的ICU质量措施，在一个队列的医院。通过改善这些指标的表现，我们可以降低死亡率、发病率和ICU住院时间。(C)2003年爱思唯尔公司All rights reserved.
Purpose: To develop and implement a set of valid and reliable yet practical measures of intensive care units (ICU) quality of care in a cohort of ICUs and to estimate, based on current performance, the potential opportunity to improve quality.Methods: We included 13 adult medical and surgical ICUs in urban community teaching and community hospitals. To monitor performance on previously identified quality measures, we developed 3 data collection tools: the Team Leader, Daily Rounding, and Infection Control forms. These tools were pilot tested, validated, and modified before implementation. We used published estimates of efficacy to estimate the clinical and economic effect of our current performance for each of the process measures: appropriate sedation, prevention of ventilator-associated pneumonia, appropriate peptic ulcer disease (PUD) prophylaxis, appropriate deep venous thrombosis (DVT) prophylaxis, and appropriate use of blood transfusions.Results: Performance varied widely among the 13 ICUs and within ICUs. The median percentage of days in which ventilated patients received therapies that ought to was 64% for appropriate sedation, 67% for elevating head of bed, 89% for PUD prophylaxis, and 87% for DVT prophylaxis. The median rate of appropriate transfusion was 33%. The failure to use these therapies may lead to excess morbidity, mortality, and ICU length of stay.Conclusion: To improve quality of care, we must measure our performance. This pilot study suggests that it is feasible to implement a broad set of ICU quality measures in a cohort of hospitals. By improving performance on these measures, we may realize reduced mortality, morbidity, and ICU length of stay. (C) 2003 Elsevier Inc. All rights reserved.