Reducing PICU-to-Floor Time-to-Transfer Decision in Critically Ill Bronchiolitis Patients using Quality Improvement Methodology.
Reducing PICU-to-Floor Time-to-Transfer Decision in Critically Ill Bronchiolitis Patients using Quality Improvement Methodology.
复制标题
使用质量改进方法，在重症细支气管炎患者中降低了PICU至地板的转移决策。
DOI：
10.1097/pq9.0000000000000506
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发表时间：
2022-01
影响因子：
1.1
通讯作者：
Brittan M
中科院分区：
文献类型：
--
作者：
Fritz CQ;Martin B;Riccolo M;Fennell M;Rolison E;Carpenter T;Bajaj L;Tyler A;Brittan M
补充数字内容可在正文中找到。病毒性毛细支气管炎的机构路径通常不包括从PICU降级的具体标准。转移偏好的变化可以延长PICU的停留时间。我们的目标是通过标准化PICU毛细支气管炎队列的PICU到地板转移评估，将从达到地板合适的加热高流量鼻管(HHF)设置到转移决策的时间减少20%。我们纳入了2019年10月至2020年4月PICU毛细支气管炎住院患者，他们6个月至2岁，在遭遇期间没有合并症或插管。我们的干预措施包括介绍转让标准和标准化转让准备情况评估。主要结果是从达到最低限度的高频设置[每分钟8 L(LPM)]到下达转接订单(“转接时间决定”)所需的时间。次要结果是PICU的住院时间。主要的流程衡量指标是转至≥6 LPM HHF的患者比例。平衡措施包括快速反应小组激活和计划外PICU重新入院。我们评估了2018年12月至2019年3月期间符合纳入标准的入院人数作为干预前基线。特殊原因的变化表明我们的主要结果和过程措施有所改善。基线与干预后的比较显示，中位转移决定时间(14.4-7.8h；P<；0.001)减少，而≥6LPM转移的儿童增加(51%-72%；P<；0.001)。我们没有观察到PICU住院时间或平衡措施的变化。标准化的降级标准和转院准备情况评估减少了离开PICU的转院决定时间，并增加了病毒性毛细支气管炎儿童在≥6LPM HHF中转院的比例，而不会增加PICU的再入院率。
Supplemental Digital Content is available in the text. Specific criteria for de-escalation from the PICU are often not included in viral bronchiolitis institutional pathways. Variability of transfer preferences can prolong PICU length of stay. We aimed to decrease the time from reaching floor-appropriate heated high flow nasal cannula (HHF) settings to the transfer decision by 20% through standardizing PICU-to-floor transfer assessment in a PICU bronchiolitis cohort. We included PICU bronchiolitis admissions from October 2019 to April 2020, who were 6-months to 2-years-old with no comorbidities nor intubation during their encounter. Our intervention bundle included introduction of transfer criteria and standardization of transfer-readiness assessment. The primary outcome was time from reaching floor-appropriate HHF settings [8 L per minutes (Lpm)] to placement of the transfer order (“time-to-transfer decision”). The secondary outcome was PICU length of stay. The main process measure was the proportion of patients transferred on ≥6 Lpm HHF. Balancing measures included Rapid Response Team activation and unplanned PICU readmission. We assessed admissions meeting inclusion criteria from December, 2018-March, 2019 for the preintervention baseline. Special cause variation indicated improvement in our primary outcome and process measures. Comparison of baseline to postintervention revealed a reduction in median time-to-transfer decision (14.4–7.8 hours; P < 0.001) and increase in children transferred on ≥6 Lpm (51%–72%; P < 0.001). We observed no change in PICU length of stay or balancing measures. Standardizing de-escalation criteria and transfer-readiness assessment reduced the time-to-transfer decision out of the PICU and increased the proportion transferred on ≥6 Lpm HHF for children with viral bronchiolitis without increasing PICU readmissions.