Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study.
Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study.
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DOI：
10.1097/ccm.0000000000002449
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发表时间：
2017-08
影响因子：
8.8
通讯作者：
Bates, David W.
中科院分区：
文献类型：
--
作者：
Dykes, Patricia C.;Rozenblum, Ronen;Dalal, Anuj;Massaro, Anthony;Chang, Frank;Clements, Marsha;Collins, Sarah;Donze, Jacques;Fagan, Maureen;Gazarian, Priscilla;Hanna, John;Lehmann, Lisa;Leone, Kathleen;Lipsitz, Stuart;McNally, Kelly;Morrison, Conny;Samal, Lipika;Mlaver, Eli;Schnock, Kumiko;Stade, Diana;Williams, Deborah;Yoon, Catherine;Bates, David W.
缺乏全面评估干预措施以改善团队沟通并使患者和护理伙伴参与ICU的研究。这项研究考察了内科ICU中以患者为中心的护理和参与计划的有效性。前瞻性干预研究。大型三级护理中心的医疗ICU。2013年7月至2014年5月和2014年7月至2015年5月共收治病人2,105人(干预前1,030人，干预期间1,075人)。结构化的以患者为中心的护理和参与培训计划和基于网络的技术，包括ICU安全核对表、制定共享护理计划的工具和消息传递平台。患者和护理合作伙伴可以访问在线门户，以查看健康信息、参与护理计划并与提供者进行交流。主要结果是总的不良事件发生率。次要结果包括患者和护理伙伴的满意度、护理计划的一致性和资源利用。我们包括2105名患者入院(1030名基线患者和1075名干预期患者)。在干预期间，不良事件的总发生率下降了29%，从每千病人日59.0例(95%可信区间51.867.2)降至每千病人日41.9%(95%可信区间36.348.3；p<；0.001)。患者的总体医院满意度从71.8%(95%可信区间，61.1%-82.6%)提高到93.3%(95%可信区间，88.298.4；p<；0.001)，护理伙伴满意度从84.3%(95%可信区间，81.3%-87.3%)提高到90.0(95%可信区间，88.1-91.9；p<；0.001)。护理计划一致性或资源利用率没有变化。在ICU中实施结构化的团队沟通和患者参与计划与不良事件的减少和患者和护理伙伴满意度的提高相关。
Studies comprehensively assessing interventions to improve team communication and to engage patients and care partners in ICUs are lacking. This study examines the effectiveness of a patient-centered care and engagement program in the medical ICU. Prospective intervention study. Medical ICUs at large tertiary care center. Two thousand one hundred five patient admissions (1,030 before and 1,075 during the intervention) from July 2013 to May 2014 and July 2014 to May 2015. Structured patient-centered care and engagement training program and web-based technology including ICU safety checklist, tools to develop shared care plan, and messaging platform. Patient and care partner access to online portal to view health information, participate in the care plan, and communicate with providers. Primary outcome was aggregate adverse event rate. Secondary outcomes included patient and care partner satisfaction, care plan concordance, and resource utilization. We included 2,105 patient admissions, (1,030 baseline and 1,075 during intervention periods). The aggregate rate of adverse events fell 29%, from 59.0 per 1,000 patient days (95% CI, 51.8–67.2) to 41.9 per 1,000 patient days (95% CI, 36.3–48.3; p < 0.001), during the intervention period. Satisfaction improved markedly from an overall hospital rating of 71.8 (95% CI, 61.1–82.6) to 93.3 (95% CI, 88.2–98.4; p < 0.001) for patients and from 84.3 (95% CI, 81.3–87.3) to 90.0 (95% CI, 88.1–91.9; p < 0.001) for care partners. No change in care plan concordance or resource utilization. Implementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction.