Reducing Inappropriate Urinary Catheter Use in the Emergency Department: Comparing Two Collaborative Structures.
Reducing Inappropriate Urinary Catheter Use in the Emergency Department: Comparing Two Collaborative Structures.
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DOI：
10.1017/ice.2017.256
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发表时间：
2018-01
影响因子：
4.5
通讯作者：
Saint S
中科院分区：
文献类型：
--
作者：
Greene MT;Fakih MG;Watson SR;Ratz D;Saint S
导尿管，其中许多是放置在急诊科（艾德）设置，往往是不合适的，他们与感染性和非感染性并发症。尽管几项评价干预效果的研究都集中在减少艾德环境中的导管使用，但尚未对实施这些干预的组织背景进行比较。Ascension卫生系统中共有18家医院（即基于系统的医院）和密歇根州的16家医院（即由密歇根州卫生和医院协会领导的州立医院）实施了以减少导尿管使用为重点的艾德干预措施。在两种医院类型中收集了关于艾德中导尿管放置、导管使用适应症和存在导管放置医嘱的数据，以进行干预。多水平负二项回归被用来比较基于系统与基于状态的干预措施。将来自基于系统的干预的总计13，215例患者（889例使用导管）与来自基于状态的干预的12，104例患者（718例使用导管）进行了比较。与基于州的干预相比，基于系统的干预在艾德中观察到导尿管放置的统计学显著和可持续的减少（发生率比，0.79; P = 0.02）和导尿管的适当使用的改善（比值比[OR]，1.86; P = 0.004）。没有观察到合作结构在医生医嘱放置导尿管方面的差异（OR，1.14; P = 0.60）。艾德干预，包括建立适当的导管放置的机构指南，并确定临床冠军，以促进遵守与减少不必要的导尿管的使用下，基于系统的协作结构。
Urinary catheters, many of which are placed in the emergency department (ED) setting, are often inappropriate, and they are associated with infectious and noninfectious complications. Although several studies evaluating the effect of interventions have focused on reducing catheter use in the ED setting, the organizational contexts within which these interventions were implemented have not been compared. A total of 18 hospitals in the Ascension health system (ie, system-based hospitals) and 16 hospitals in the state of Michigan (ie, state-based hospitals led by the Michigan Health and Hospital Association) implemented ED interventions focused on reducing urinary catheter use. Data on urinary catheter placement in the ED, indications for catheter use, and presence of physician order for catheter placement were collected for interventions in both hospital types. Multilevel negative binomial regression was used to compare the system-based versus state-based interventions. A total of 13,215 patients (889 with catheters) from the system-based intervention were compared to 12,104 patients (718 with catheters) from the state-based intervention. Statistically significant and sustainable reductions in urinary catheter placement (incidence rate ratio, 0.79; P = .02) and improvements in appropriate use of urinary catheters (odds ratio [OR], 1.86; P = .004) in the ED were observed in the system-based intervention, compared to the state-based intervention. Differences by collaborative structure in changes in presence of physician order for urinary catheter placement (OR, 1.14; P = .60) were not observed. An ED intervention consisting of establishing institutional guidelines for appropriate catheter placement and identifying clinical champions to promote adherence was associated with reducing unnecessary urinary catheter use under a system-based collaborative structure.
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影响因子：
5.7
作者：
Krein, Sarah L.;Kowalski, Christine P.;Saint, Sanjay
通讯作者：
Saint, Sanjay
超越感染：设备利用率是尿导管危害的性能指标。
影响因子：
4.5
作者：
Fakih MG;Gould CV;Trautner BW;Meddings J;Olmsted RN;Krein SL;Saint S
通讯作者：
Saint S
影响因子：
4.5
作者：
Fakih, Mohamad G.;George, Christine;Saint, Sanjay
通讯作者：
Saint, Sanjay
影响因子：
--
作者：
Damschroder, L. J.;Banaszak-Holl, J.;Krein, S. L.
通讯作者：
Krein, S. L.
影响因子：
1.7
作者：
Patrizzi, Kathleen;Fasnacht, Allen;Manno, Martin
通讯作者：
Manno, Martin