Effect of a Real-Time Pediatric ICU Safety Bundle Dashboard on Quality Improvement Measures
Effect of a Real-Time Pediatric ICU Safety Bundle Dashboard on Quality Improvement Measures
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DOI：
10.1016/s1553-7250(15)41053-0
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发表时间：
2015-09-01
影响因子：
2.3
通讯作者：
Spaeder, Michael C.
中科院分区：
文献类型：
--
作者：
Shaw, Susanna J.;Jacobs, Brian;Spaeder, Michael C.
背景：患者每日目标表已被证明可以提高对医院政策的依从性，但可能不能代表儿科ICU （PICU）环境中护理交付的动态性质。在儿童国家卫生系统（华盛顿特区）进行了一项研究，以确定一个可见的、全单位范围的、实时的仪表板对遵守质量和安全措施的及时性的影响。方法：创建一个自动电子健康记录（EHR）查询工具来评估PICU安全包的依从性。每五分钟自动进行EHR合规性查询和仪表板更新。实时可视显示治疗同意、约束令、导尿管、深静脉血栓（DVT）预防、Braden Q评分和药物调节等数据。基线依从性和不依从性持续时间在三个时间段内建立：第一，在仪表板激活之前；第二次是在仪表板激活后一个月；第三次是在激活后的三个月。结果：共纳入450例患者。在第一和第三个时间段，从PICU入院到获得治疗同意的中位时间减少了49%，从393分钟减少到202分钟（p = 0.05）。留置导尿管的患者从第1期的16例（32%）减少到第2期和第3期的11例（19%）（p = 0.01）。用药和解完成率从第一个时间段的80%提高到随后两个时间段的93%和92% （p = 0.002）。这三个时期在禁制令、深静脉血栓预防、压疮发展或恶化方面没有差异。结论：单位范围的仪表板可以提高对潜在干预措施的认识，以动态的方式影响PICU中的患者安全。
Background: Patient daily goal sheets have been shown to improve compliance with hospital policies but might not represent the dynamic nature of care delivery in the pediatric ICU (PICU) setting. A study was conducted at Children's National Health System (Washington, DC) to determine the effect of a visible, unitwide, real-time dashboard on timeliness of compliance with quality and safety measures.Methods: An automated electronic health record (EHR)-querying tool was created to assess compliance with a PICU Safety Bundle. Querying of the EHR for compliance and updating of the dashboard automatically occurred every five minutes. A real-time visual display showed data on presence of consent for treatment, restraint orders, presence of urinary catheters, deep venous thrombosis (DVT) prophylaxis, Braden Q score, and medication reconciliation. Baseline compliance and duration of noncompliance was established during three time periods: the first, before activation of the dashboard; the second, at one month following activation of the dashboard; and the third, at three months after activation.Results: A total of 450 patients were included in the analysis. Between the first and third time periods, the median time from PICU admission to obtaining treatment consent decreased by 49%, from 393 to 202 minutes (p = .05). The number of patients with urinary catheters in place > 96 hours decreased from 16 (32%) in Period 1 to 11 (19%) for Periods 2 and 3 combined (p = .01). Completion of medication reconciliation improved from 80% in the first time period to 93% and 92%, respectively, in the subsequent two periods (p = .002). There was no difference between the three periods in presence of restraint orders, DVT prophylaxis, or development or worsening of pressure ulcers.Conclusions: A unitwide dashboard can increase awareness for potential interventions, affecting patient safety in the PICU in a dynamic manner.