The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU.
The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU.
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质量改善干预对医学ICU中感知的睡眠质量和认知的影响。
DOI：
10.1097/ccm.0b013e3182746442
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发表时间：
2013-03
影响因子：
8.8
通讯作者：
Needham DM
中科院分区：
文献类型：
--
作者：
Kamdar BB;King LM;Collop NA;Sakamuri S;Colantuoni E;Neufeld KJ;Bienvenu OJ;Rowden AM;Touradji P;Brower RG;Needham DM
为了确定质量改进(QI)干预是否改善睡眠和精神错乱/认知。观察性的、岗位前的设计。美国的一家三级学院医院。300名内科重症监护病房(MICU)患者。这一覆盖整个MICU的项目包括一个“日常护理”基线阶段，随后是一个QI阶段，该阶段包括在ICU工作人员每日提醒清单的帮助下实施的多方面促进睡眠的干预措施。ICU的主要结果是感知的睡眠质量和噪音等级(使用有效和可靠的Richards-Campbell睡眠问卷[RCSQ]在0-100分范围内测量)和神志不清/昏迷的天数。次要结果包括ICU和住院时间以及死亡率。ICU后认知和感知睡眠质量的测量在ICU患者子组中进行评估。在基线和睡眠QI阶段，分别有122名和178名患者在ICU住了一晚，占634和826个人日。在这些患者中，78例(63.9%)和83例(46.6%)接受了机械通气。在826个病人日QI期间，核对表项目完成率从86-94%不等。在QI与基线阶段的多变量回归分析中，总体RCSQ睡眠质量评分的改善没有达到统计学意义，但在日常噪音评分(平均值±标准差：65.9±26.6vs.60.5±26.3，P=0.001)、妄想/昏迷发生率(优势比：0.46；95%可信区间，0.23~0.89；P=0.02)和每日妄想/昏迷状态(优势比：1.64；95%可信区间，1.04~2.58；P=0.03)方面有显著改善。二次ICU结局和ICU后结局的改善没有达到统计学意义。在ICU范围内进行QI干预以改善睡眠和精神错乱是可行的，并且与夜间噪音感知、精神错乱/昏迷发生率和日常精神错乱/无昏迷状态的显著改善相关。感觉到的睡眠质量的改善没有达到统计学意义。
To determine if a quality improvement (QI) intervention improves sleep and delirium/cognition. Observational, pre-post design. A tertiary academic hospital in the US. 300 medical ICU (MICU) patients. This MICU-wide project involved a “usual care” baseline stage, followed by a QI stage incorporating multi-faceted sleep-promoting interventions implemented with the aid of daily reminder checklists for ICU staff. Primary ICU outcomes were perceived sleep quality and noise ratings (measured on a 0-100 scale using the valid and reliable Richards-Campbell Sleep Questionnaire [RCSQ]) and delirium/coma-free days. Secondary outcomes included ICU and hospital length of stay and mortality. Post-ICU measures of cognition and perceived sleep quality were evaluated in an ICU patient subset. During the baseline and sleep QI stages there were 122 and 178 patients, respectively, with >1 night in the ICU, accounting for 634 and 826 patient-days. Within the groups, 78 (63.9%) and 83 (46.6%) patients received mechanical ventilation. Over the 826 patient-day QI period, checklist item completion rates ranged from 86-94%. In multivariable regression analysis of the QI vs. baseline stages, improvements in overall RCSQ sleep quality ratings did not reach statistical significance, but there were significant improvements in daily noise ratings (mean ± standard deviation: 65.9 ± 26.6 vs. 60.5 ± 26.3, P=0.001), incidence of delirium/coma (odds ratio: 0.46; 95% confidence interval, 0.23-0.89; P=0.02), and daily delirium/coma-free status (odds ratio: 1.64; 95% confidence interval, 1.04-2.58; P=0.03). Improvements in secondary ICU outcomes and post-ICU outcomes did not reach statistical significance. An ICU-wide QI intervention to improve sleep and delirium is feasible and associated with significant improvements in perceived nighttime noise, incidence of delirium/coma, and daily delirium/coma-free status. Improvement in perceived sleep quality did not reach statistical significance.