A primer on leading the improvement of systems
A primer on leading the improvement of systems
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DOI：
10.1136/bmj.312.7031.619
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发表时间：
1996-03-09
影响因子：
--
通讯作者：
Berwick, DM
中科院分区：
文献类型：
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作者：
Berwick, DM
我从来没有见过吉米（6岁的男孩）或他的母亲（一个内城单身十几岁的父母）之前。他的哮喘发作很严重，他的最大呼气流速只有正常的35%。20年前，我的下一个步骤是开始支气管扩张剂治疗，叫救护车，把男孩送到医院。这也是10年前的故事，或者5年，或者2年前的故事。但是今天，当我走进房间时，母亲递给我她最新的治疗清单，包括β2受体激动剂的雾化治疗，她用家里安装的设备进行治疗。接下来是她对吉米缓慢改善的峰值流量水平的图表，这是她在家里测量和绘制的，经过哮喘外展护士的培训。然后，她给了我护士的手机号码，沿着了一个关于下一次给她儿子服用药物的具体建议，这种药物过去曾起过作用，但她还不能在家里使用。
I had never met either Jimmy (the 6 year old boy) or his mother (an inner city single teenage parent) before. His asthma attack was severe, his peak expiratory flow rate only 35% of normal. Twenty years ago my next steps would have been to begin bronchodilator treatment, call an ambulance, and send the boy to hospital. That also would have been the story 10 years ago, or five, or two.But today, when I entered the room, the mother handed me her up to date list of treatments, including nebuliser treatment with β2 agonists, that she had administered with equipment that had been installed in her home. It continued with her graph of Jimmy's slowly improving peak flow levels, which she had measured and charted at home, having been trained by the asthma outreach nurse. She then gave me the nurse's cellular telephone number, along with a specific recommendation on the next medication to try for her son, one that had worked in the past but was not yet available for her to use at home.