Intermediate care to intensive care triage: A quality improvement project to reduce mortality.
Intermediate care to intensive care triage: A quality improvement project to reduce mortality.
复制标题
DOI：
10.1016/j.jcrc.2017.08.002
复制
发表时间：
2017-12
影响因子：
3.7
通讯作者：
Needham DM
中科院分区：
文献类型：
--
作者：
Hager DN;Chandrashekar P;Bradsher RW 3rd;Abdel-Halim AM;Chatterjee S;Sawyer M;Brower RG;Needham DM
医疗病人的护理需求超过了普通病房的可行性，但谁不明显需要重症监护，可能会被接纳到一个中间护理单位（IMCU）。一些IMCU患者病情恶化，需要入住重症监护室（MICU）。2012年，约翰霍普金斯IMCU的工作人员表示担心患者的紧急程度和MICU入院门槛太高。此外，居民和监督医生之间的共享分诊决策并不一致。为了改善我们的分诊流程，我们使用了4 E质量改进框架（参与，教育，执行，评估）来（1）教育居民和研究员关于分诊原则和（2）促进MICU居民进行分诊和监督医生之间的实时沟通。在基线期（n=83; 2012年7月至12月）和干预期（n=94; 2013年7月至12月）从IMCU转入MICU的患者中，未校正死亡率从34%降至21%（p=0.06）。在调整疾病严重程度、入院诊断和床位可用性后，干预期间的死亡几率低于基线阶段（OR 0.33; 95%CI 0.11-0.98）。通过采用结构化的质量改进流程，针对分诊教育和增加住院医师/主管沟通，我们证明了从IMCU转移到MICU的患者的死亡率降低。
Medical patients whose care needs exceed what is feasible on a general ward, but who do not clearly require critical care, may be admitted to an intermediate care unit (IMCU). Some IMCU patients deteriorate and require medical intensive care unit (MICU) admission. In 2012, staff in the Johns Hopkins IMCU expressed concern that patient acuity and the threshold for MICU admission were too high. Further, shared triage decision-making between residents and supervising physicians did not consistently occur. To improve our triage process, we used a 4Es quality improvement framework (engage, educate, execute, evaluate) to (1) educate residents and fellows regarding principles of triage and (2) facilitate real-time communication between MICU residents conducting triage and supervising physicians. Among patients transferred from the IMCU to the MICU during baseline (n=83; July–December 2012) and intervention phases (n=94; July–December 2013), unadjusted mortality decreased from 34% to 21% (p=0.06). After adjusting for severity of illness, admitting diagnosis, and bed availability, the odds of death were lower during the intervention vs. baseline phase (OR 0.33; 95%CI 0.11–0.98). Using a structured quality improvement process targeting triage education and increased resident/supervisor communication, we demonstrated reduced mortality among patients transferred from the IMCU to the MICU.
登录
查看更多内容
影响因子：
2.6
作者：
Escobar, Gabriel J.;Greene, John D.;Kipnis, Patricia
通讯作者：
Kipnis, Patricia
影响因子：
2.6
作者：
Delgado, M. Kit;Liu, Vincent;Escobar, Gabriel J.
通讯作者：
Escobar, Gabriel J.
影响因子：
--
作者：
DeVita, MA;Braithwaite, RS;Simmons, RL
通讯作者：
Simmons, RL
影响因子：
8.8
作者：
Azoulay, É;Pochard, F;Dhainaut, JF
通讯作者：
Dhainaut, JF
影响因子：
9.6
作者：
BONE, RC;MCELWEE, NE;GLUCK, EH
通讯作者：
GLUCK, EH