Variation in restraint use between hospitals: a multilevel analysis of multicentre prevalence measurements in Switzerland and Austria.
Variation in restraint use between hospitals: a multilevel analysis of multicentre prevalence measurements in Switzerland and Austria.
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DOI：
10.1186/s12913-021-06362-y
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发表时间：
2021-04-20
影响因子：
2.8
通讯作者：
Zwakhalen S
中科院分区：
文献类型：
--
作者：
Thomann S;Hahn S;Bauer S;Richter D;Zwakhalen S
在躯体急症护理医院环境中的约束使用中，常规和制度文化似乎起着重要作用。这意味着类似的病人情况将在一家医院受到限制，而在另一家医院，这种情况将在没有限制的情况下得到管理。这种做法的差异似乎在道德和法律上是有问题的。组织的具体因素，如指南的可用性的影响进行了讨论。然而，这些因素在医院一级的相关性很少被调查。因此，本研究的目的是：a）确定在医院层面（医院一般效应）可以解释多少约束使用的差异; B）检查组织因素对约束使用的影响（特定的背景效应）。对横断面多中心数据进行了次要数据分析。在瑞士和奥地利的急性护理医院的三次质量测量（2016-2018）期间收集了数据。纳入了来自不同医学专业且征得知情同意的18岁以上住院患者。进行描述性分析和多水平Logistic回归分析。该研究包括来自140家医院的29，477名患者。至少有一次约束的患者的30天患病率为8.7%（n = 2577）。关于约束使用和进修课程的护理人员的指导方针的可用性与约束使用较少（比值比= 0.60和0.75）。通过添加医院作为随机效应，模型的解释方差从24%增加到55%。即使考虑到病人的特点，医院之间使用限制措施的情况也有很大差异。查明出于常规或机构文化使用限制的情况，似乎是减少限制的一个重要方法。投资于适当的结构和员工知识可以促进尽可能提供无限制的护理。在线版本包含补充材料，可通过10.1186/s12913-021-06362-y获得。
In restraint use in the somatic acute-care hospital setting, routine and institutional culture seem to play an important role. This implies that similar patient situations would be managed with restraints in one hospital, while in another hospital the situation would be managed without restraints. This practice variation appears to be ethically and legally questionable. The influence of organisation-specific factors such as the availability of guidelines is discussed. However, the relevance of such factors at the hospital level has been rarely investigated to date. Therefore, the aims of this study were a) to determine how much variance in restraint use can be explained on the hospital level (hospital general effect) and b) to examine the impact of organisational factors on restraint use (specific contextual effects). A secondary data analysis of cross-sectional multicentre data was performed. Data were collected during three quality measurements (2016–2018) in acute-care hospitals in Switzerland and Austria. Hospitalised patients from different medical specialties aged 18+ with informed consent were included. Descriptive analysis and multilevel logistic regression analysis were performed. The study included 29,477 patients from a total of 140 hospitals. The 30-day prevalence rate of patients with at least one restraint was 8.7% (n = 2577). The availability of guidelines regarding restraint use and refresher courses for nursing staff were associated with less restraint use (odds ratios = 0.60 and 0.75). By adding the hospital as a random effect, the explained variance of the model increased from 24 to 55%. The use of restraints varies widely between hospitals, even considering patient characteristics. The identification of situations in which restraints were used out of routine or institutional culture appears to be an important approach in restraint reduction. Investments in appropriate structures and employee knowledge can facilitate providing restraint-free care as much as possible. The online version contains supplementary material available at 10.1186/s12913-021-06362-y.
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影响因子：
5.8
作者：
Chou, M. -Y.;Hsu, Y. -H.;Lin, Y. -T.
通讯作者：
Lin, Y. -T.
影响因子：
8.1
作者：
Krueger, Caecilia;Mayer, Herbert;Meyer, Gabriele
通讯作者：
Meyer, Gabriele
影响因子：
3.4
作者：
Farina-Lopez, Emilio;Estevez-Guerra, Gabriel J.;Capezuti, Elizabeth A.
通讯作者：
Capezuti, Elizabeth A.
DOI：
10.1136/bmjquality.u211050.w4430
发表时间：
2016-01-01
期刊：
BMJ quality improvement reports
影响因子：
--
作者：
Bell, Alyssa;Gallacher, Neil
通讯作者：
Gallacher, Neil
影响因子：
6.8
作者：
AKAIKE, H
通讯作者：
AKAIKE, H