Effects of a National Quality Improvement Collaborative on ABCDEF Bundle Implementation.
Effects of a National Quality Improvement Collaborative on ABCDEF Bundle Implementation.
复制标题
DOI：
10.4037/ajcc2022768
复制
发表时间：
2022-01-01
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
ABCDEF捆绑包（评估、预防和管理疼痛和谵妄;自发觉醒和呼吸试验;镇痛/镇静的选择;早期活动;和家庭参与）改善了重症监护室的结局，但实践中的采用率很低。评估质量改进协作参与对ABCDEF捆绑包绩效的影响。这项中断的时间序列分析包括来自68个美国重症监护室的15226名成年人的20个月的捆绑性能数据。分段回归模型被用来量化完整的和单独的束元素性能随时间的变化，并比较性能模式之前（6个月）和之后（14个月）的合作启动。完全捆绑性能率在基线时非常低（<4%），但在结束时增加到12%。完成捆绑性能增加了2个百分点（SE，0.9; P = 0.06）后立即合作启动。随后的每个月与0.6个百分点的增加相关（SE，0.2; P = 0.04）。疼痛评估（7.6% [SE，2.0%]，P = 0.002）、镇静评估（9.1% [SE，3.7%]，P = 0.02）和家庭参与（7.8% [SE，3%]，P = 0.02）在开始后立即显著增加，然后每月以与基线期相同的速度增加。自发觉醒/呼吸试验和早期活动的表现率最低。质量改进协作参与导致临床上有意义的，但小的和可变的，在捆绑性能的改善。机会仍然存在，以提高采用镇静，机械通气，和早期活动的做法。
The ABCDEF bundle (Assess, prevent, and manage pain and Delirium; Both spontaneous awakening and breathing trials; Choice of analgesia/sedation; Early mobility; and Family engagement) improves intensive care unit outcomes, but adoption into practice is poor. To assess the effect of quality improvement collaborative participation on ABCDEF bundle performance. This interrupted time series analysis included 20 months of bundle performance data from 15 226 adults admitted to 68 US intensive care units. Segmented regression models were used to quantify complete and individual bundle element performance changes over time and compare performance patterns before (6 months) and after (14 months) collaborative initiation. Complete bundle performance rates were very low at baseline (<4%) but increased to 12% by the end. Complete bundle performance increased by 2 percentage points (SE, 0.9; P = .06) immediately after collaborative initiation. Each subsequent month was associated with an increase of 0.6 percentage points (SE, 0.2; P = .04). Performance rates increased significantly immediately after initiation for pain assessment (7.6% [SE, 2.0%], P = .002), sedation assessment (9.1% [SE, 3.7%], P = .02), and family engagement (7.8% [SE, 3%], P = .02) and then increased monthly at the same speed as the trend in the baseline period. Performance rates were lowest for spontaneous awakening/breathing trials and early mobility. Quality improvement collaborative participation resulted in clinically meaningful, but small and variable, improvements in bundle performance. Opportunities remain to improve adoption of sedation, mechanical ventilation, and early mobility practices.
登录
查看更多内容
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
8.8
作者：
Ely, EW;Margolin, R;Inouye, SK
通讯作者：
Inouye, SK
影响因子：
8.8
作者：
Balas MC;Vasilevskis EE;Olsen KM;Schmid KK;Shostrom V;Cohen MZ;Peitz G;Gannon DE;Sisson J;Sullivan J;Stothert JC;Lazure J;Nuss SL;Jawa RS;Freihaut F;Ely EW;Burke WJ
通讯作者：
Burke WJ
影响因子：
8.8
作者：
Barr, Juliana;Fraser, Gilles L.;Jaeschke, Roman
通讯作者：
Jaeschke, Roman
影响因子：
120.7
作者：
Mehta, Sangeeta;Burry, Lisa;Meade, Maureen
通讯作者：
Meade, Maureen