ICU team composition and its association with ABCDE implementation in a quality collaborative.
ICU team composition and its association with ABCDE implementation in a quality collaborative.
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DOI：
10.1016/j.jcrc.2017.09.180
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发表时间：
2018-04
影响因子：
3.7
通讯作者：
Iwashyna TJ
中科院分区：
文献类型：
--
作者：
Costa DK;Valley TS;Miller MA;Manojlovich M;Watson SR;McLellan P;Pope C;Hyzy RC;Iwashyna TJ
唤醒、呼吸协调、妄想和早期活动捆绑(ABCDE)应该包括一个跨专业团队，但没有研究描述什么团队组成支持实施。我们在MHA Keystone Center ICU 2015研讨会上进行了一项调查。我们通过护士、呼吸治疗师、内科医生、理疗师、护士/医生助理或护理助理参与1)自发觉醒试验(SAT)、2)自发呼吸试验、3)精神错乱和4)早期活动的频率来衡量团队组成。我们使用5点Likert(“每个患者护理的常规部分”--“没有实施计划”)来评估ABCDE的实施。我们使用有序Logistic回归来检查团队组成和ABCDE实施，调整混杂因素和分组。在293份调查中(75%的应答率)，我们发现频繁的护士[OR 6.1(1.1-34.9)]和医生参与SATS[OR 4.2(1.3-13.4)]，护士[OR 4.7(1.6-13.4)]和护士助理参与精神错乱[OR 3.9(1.2-13.5)]，护士[OR 2.8(1.2-6.7)]，医生[OR(3.6(1.2-10.3)]]，护理助理参与早期活动[OR 2.3(1.1-4.8)]与实施常规ABCDE的几率显著相关。ABCDE的实施与团队成员的频繁参与有关，这表明需要进行角色表达和协调。
Awakening, Breathing Coordination, Delirium, and Early Mobility bundle (ABCDE) should involve an interprofessional team, yet no studies describe what team composition supports implementation. We administered a survey at MHA Keystone Center ICU 2015 workshop. We measured team composition by the frequency of nurse, respiratory therapist, physician, physical therapist, nurse practitioner/physician assistant or nursing assistant involvement in 1) spontaneous awakening trials (SATs), 2) spontaneous breathing trials, 3) delirium and 4) early mobility. We assessed ABCDE implementation using a 5-point Likert (“routine part of every patient’s care” - “no plans to implement”). We used ordinal logistic regression to examine team composition and ABCDE implementation, adjusting for confounders and clustering. From 293 surveys (75% response rate), we found that frequent nurse [OR 6.1 (1.1 –34.9)] and physician involvement [OR 4.2 (1.3 – 13.4)] in SATs, nurse [OR 4.7 (1.6–13.4)] and nursing assistant’s involvement [OR 3.9 (1.2–13.5)] in delirium and nurse [OR 2.8 (1.2–6.7)], physician [OR (3.6 (1.2–10.3)], and nursing assistants’ involvement [OR 2.3 (1.1–4.8)] in early mobility were significantly associated with higher odds of routine ABCDE implementation. ABCDE implementation was associated with frequent involvement of team members, suggesting a need for role articulation and coordination.
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