Applying the New Institute for Healthcare Improvement Inpatient Waste Tool to Identify "Waste" in the Intensive Care Unit
Applying the New Institute for Healthcare Improvement Inpatient Waste Tool to Identify "Waste" in the Intensive Care Unit
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DOI：
10.1097/jhq.0000000000000040
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发表时间：
2016-09-01
影响因子：
1.3
通讯作者：
Patel, Bela
中科院分区：
文献类型：
--
作者：
Almoosa, Khalid F.;Luther, Katharine;Patel, Bela
医疗浪费-不适当地使用医疗资源，不仅不会给患者带来好处，反而会增加成本，甚至造成伤害-可能是导致高医疗成本的一个重要因素。该项目旨在应用当地改进的医疗保健改进研究所(IHI)开发的一种新的废物识别工具，以衡量重症监护病房(ICU)床位不适当使用的普遍性和原因，这是一种潜在的废物。医生在3个月的时间里确定了16个床位的封闭式内科ICU(MICU)和10个床位的半封闭式移植外科ICU(TSICU)中不必要的天数(即浪费)及其原因。在两个ICU住院的513名患者总计1631人日的数据显示，15%的MICU日和25.8%的TSICU日是不必要的。尽管每个ICU浪费的原因不同，但患者转移出ICU的延迟、临终决策和程序延迟是最常见的。不同医生对废物的测定也不同，在MICU从4.5%到27.7%，在TSICU从0%到37.5%。这项研究发现，IHI Waste工具可以有效地用于识别ICU中的废物，这种情况很常见，并根据ICU类型和医生的看法而有所不同。
Healthcare waste-the inappropriate use of healthcare resources that provides no benefit to patients yet contributes to cost and even harm-is a potentially significant contributor to high healthcare costs. This project aimed to apply a new locally modified Institute for Healthcare Improvement (IHI)-developed waste identification tool to measure the prevalence of and reason for the inappropriate use of intensive care unit (ICU) beds, one type of potential waste. Unnecessary days (i.e., waste) and their causes in a 16-bed closed medical ICU (MICU) and a 10-bed semi-closed transplant surgical ICU (TSICU) were identified by physicians over a 3-month period. Data on 513 patients admitted to both ICUs for a total of 1,631 patient-days demonstrated that 15% of MICU days and 25.8% of TSICU days were unnecessary. Although causes of waste in each ICU differed, delays in transfer of patients out of the ICU, end-of-life decision-making, and delays in procedures were among the commonest. Determination of waste also varied among physicians, ranging from 4.5% to 27.7% in the MICU and 0%-37.5% in the TSICU. This study found that the IHI waste tool can be effectively used to identify waste in the ICU, which is common and varies based on the ICU type and physician perceptions.