Enhanced recovery clinical education programme improves quality of post-operative care.
Enhanced recovery clinical education programme improves quality of post-operative care.
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DOI：
10.1136/bmjquality.u208370.w3387
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发表时间：
2015-01-01
期刊：
影响因子：
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通讯作者：
McDonald, Ruth
中科院分区：
文献类型：
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作者：
McDonald, Ruth
质量是提高采收率(ER)的驱动原则。它通过更快地让患者好转来改善患者体验，并改变临床实践，使护理更安全、更高效。因此，急诊室患者住院时间较短。在组织结构重组和人员变动后，一个成功的ER计划开始失败。患者没有达到他们的ER目标，住院时间(LOS)增加。任命了一名急诊室护士，使方案重回正轨。这涉及到急诊室临床教育计划的多学科方法。该方案旨在发展有关术后恢复的生理学知识和作为所需干预措施基础的证据。这被认为是确保更长期的员工敬业度，同时避免不假思索的礼仪驱动的合规的关键。教育计划的成功是通过患者LOS和再入院统计数据的改善来衡量的。在临床教育计划的四个月期间，每月的LOS没有显着变化。在方案执行后六个月，与前六个月相比，损失天数减少了0.6天。在12个月时，与前12个月相比，减少了1.1天。在方案实施后的12个月中，所有选择性妇科手术的再住院天数平均减少了28天，与之前的12个月相比，每月减少了1.1名患者。提供多学科参与式教育计划提高了对急诊室的整体了解，并为患者的利益实现了急诊室的持续改善。
Quality is the driving principle of Enhanced Recovery (ER). It improves the patient experience by getting patients better sooner and changes clinical practice to make care safer and more efficient. As a consequence of ER patients spend less time in hospital. A successful ER programme began to fail after organisational restructuring and staff changes. Patients did not meet their ER goals and length of stay (LOS) increased. An ER nurse was appointed to get the programme back on track. This involved a multidisciplinary approach to an ER clinical education programme. The programme aimed to develop knowledge of the physiology of post-operative recovery and the evidence underpinning the interventions required. This was considered crucial to secure longer term staff engagement while avoiding unthinking protocol driven compliance. Success of the education programme was measured by improved outcomes in patient LOS and readmission statistics. During the four months of the clinical education programme there were no significant changes in monthly LOS. At six months post implementation of the programme there was a reduction in LOS of 0.6 days compared to the previous six months. At 12 months there was a reduction in 1.1 days compared with previous 12 months. There was a mean reduction of 28 day readmissions for all elective gynaecology surgery of 1.1 patients per month in the 12 months post programme implementation compared to the 12 months before. Delivering a multidisciplinary participatory education programme improved overall understanding of ER, and achieved sustained improvement in ER for patient benefit.