Preparing for Discharge From the Neonatal Intensive Care Unit
Preparing for Discharge From the Neonatal Intensive Care Unit
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DOI：
10.1542/peds.2018-2915
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发表时间：
2019-06-01
期刊：
影响因子：
8
通讯作者：
Smith, Vincent C.
中科院分区：
文献类型：
--
作者：
Gupta, Munish;Pursley, DeWayne M.;Smith, Vincent C.
背景：出院准备是新生儿重症监护室（NICU）家庭结局的关键决定因素。自2003年以来，使用一套广泛的结果和过程的措施，我们已经进行了持续的质量改进措施，以改善出院准备过程中，我们的新生儿重症监护室和准备出院的家庭从新生儿重症监护室。出院准备是通过使用父母和护士的调查，从我们的新生儿重症监护室出院的所有家庭。主要结果的措施包括父母自我评估的出院准备和护士评估的家庭的情感和技术出院准备。次要结局指标包括特定技术技能和情感因素的评估。过程措施包括出院时护理人员与家属的熟悉程度。随着时间的推移，通过使用统计过程控制charts.RESULTS的改善进行了分析：在所有的主要结果的措施显着改善。家庭对出院准备的自我评估从85.1%提高到89.1%;护士对家庭情绪出院准备的评估从81.2%提高到90.5%，技术出院准备从81.4%提高到87.7%。一些次要结局指标显示显著改善，而大多数保持稳定。护士熟悉出院时的家庭随着时间的推移而增加。结论：质量改进方法可以用来衡量和提高出院准备的家庭与新生儿重症监护室的婴儿。该模型可以提供必要的框架，一个结构化的方法，系统地评估和改善出院准备过程中的新生儿重症监护室。
BACKGROUND:Discharge readiness is a key determinant of outcomes for families in the NICU. Since 2003, using a broad set of outcome and process measures, we have conducted an ongoing quality improvement initiative to improve the discharge preparation process in our NICU and readiness of families being discharged from the NICU.METHODS:Iterative improvements to the discharge preparation process were made by a multidisciplinary committee. Discharge readiness was measured by using a parental and nurse survey for all families discharged from our NICU. Primary outcome measures included parental self-assessment of discharge readiness and nurse assessment of the family's emotional and technical discharge readiness. Secondary outcome measures included assessment of specific technical skills and emotional factors. Process measures included nursing familiarity with family at discharge. Improvement over time was analyzed by using statistical process control charts.RESULTS:Significant improvement was seen in all primary outcome measures. Family self-assessment of discharge readiness increased from 85.1% to 89.1%; nurse assessment of the family's emotional discharge readiness increased from 81.2% to 90.5%, and technical discharge readiness increased from 81.4% to 87.7%. Several secondary outcome measures revealed significant improvement, whereas most remained stable. Nurse familiarity with the family at discharge increased over time.CONCLUSIONS:Quality improvement methodology can be used to measure and improve discharge readiness of families with an infant in the NICU. This model can provide the necessary framework for a structured approach to systematically evaluating and improving the discharge preparation process in a NICU.