Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti.
Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti.
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规范化的急诊科观察护理提高了海地缺血性中风护理的质量。
DOI：
10.1016/j.afjem.2020.05.007
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Schuur,JeremiahD
中科院分区：
文献类型：
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作者：
Rouhani,ShadaA;Marsh,ReganH;Rimpel,Linda;Anderson,Kathryn;Outhay,Malena;Edmond,MarieCassandre;Checkett,KeeganA;Berkowitz,AaronL;Kwan,GeneF;Baugh,ChristopherW;Schuur,JeremiahD
在许多低收入国家，急诊医学不发达，面临着许多业务挑战，包括急诊科（艾德）过度拥挤和患者住院时间（LOS）延长。在高资源环境中，协议化的艾德观察单元（EDOU）护理在保持护理质量的同时降低了LOS。EDOU在低收入国家未经测试。我们评估了缺血性中风的协议EDOU护理对海地护理质量和效率的影响。方法我们于2014年1月至2015年9月在海地一家学术医院对缺血性中风的协议观察护理进行了一项前瞻性队列研究。我们将使用缺血性卒中方案在EDOU中接受治疗的患者（研究组）与方案实施前接受治疗的合格患者（基线组）以及在方案引入后接受治疗但未使用EDOU方案的合格患者（当代参考组）进行了比较。我们分析了三种护理质量指标：阿司匹林给药、物理治疗咨询和吞咽评估。我们还分析了艾德和医院LOS作为衡量效率的指标。结果与基线组相比，接受协议EDOU护理的患者获得了更高的护理质量，阿司匹林给药率更高（91% v. 17%，p < 0.001）、物理治疗咨询（50% v. 9.6%，p < 0.001）和吞咽评估（36% v. 3.7%，p < 0.001）。我们观察到研究组与当代参考组相比有类似的改善。大多数患者（92%）完全在艾德或EDOU接受治疗。LOS为非入院患者的研究组比基线组（28比19小时，p = 0.023）。ConclusionProtocolized EDOU护理缺血性卒中患者在海地改善性能的关键质量指标，但增加了LOS，可能是由于更多的干预措施。未来的研究应该检查EDOU护理的各个方面在促进更高的护理质量方面是最有效的，以及在其他疾病患者中是否可以获得类似的结果。
IntroductionIn many low-income countries, Emergency Medicine is underdeveloped and faces many operational challenges including emergency department (ED) overcrowding and prolonged patient length of stays (LOS). In high-resource settings, protocolized ED observation unit (EDOU) care reduces LOS while preserving care quality. EDOUs are untested in low-income countries. We evaluate the effect protocolized EDOU care for ischemic stroke on the quality and efficiency of care in Haiti.MethodsWe performed a prospective cohort study of protocolized observation care for ischemic stroke at a Haitian academic hospital between January 2014 and September 2015. We compared patients cared for in the EDOU using the ischemic stroke protocol (study group) to eligible patients cared for before protocol implementation (baseline group), as well as to eligible patients treated after protocol introduction but managed without the EDOU protocol (contemporary reference group). We analysed three quality of care measures: aspirin administration, physical therapy consultation, and swallow evaluation. We also analysed ED and hospital LOS as measures of efficiency.ResultsPatients receiving protocolized EDOU care achieved higher care quality compared to the baseline group, with higher rates of aspirin administration (91% v. 17%, p < 0.001), physical therapy consultation (50% v. 9.6%, p < 0.001), and swallow evaluation (36% v. 3.7%, p < 0.001). We observed similar improvements in the study group compared to the contemporary reference group. Most patients (92%) were managed entirely in the ED or EDOU. LOS for non-admitted patients was longer in the study group than the baseline group (28 v. 19 h, p = 0.023).ConclusionProtocolized EDOU care for patients with ischemic stroke in Haiti improved performance on key quality measures but increased LOS, likely due to more interventions. Future studies should examine the aspects of EDOU care are most effective at promoting higher care quality, and if similar results are achievable in patients with other conditions.