Implementation of Practice Standards for ECG Monitoring

描述（由申请人提供）：尽管医院心电图（ECG）监测技术取得了进步，但监测实践不一致，而且往往不充分。我们最近发布了ECG监测的新实践标准。我们提出的5年多中心随机临床试验的主要目的是测试实施这些标准对护士的知识和技能，护理质量和患者结局的影响。并探讨实验组效果的持续性和控制组延迟干预的效果。我们期望护士的知识和技能的增加将导致护理质量的提高，从而改善患者的预后。16家医院为心脏病患者服务的单位将参加。在获得知识和技能、护理质量和患者结局的基线测量后，医院将被随机分配到实验组或对照组。干预措施将包括心电图监测教育和实施和维持变革的战略。教育将基于网络，包括4个模块：心电图监测，心律失常监测，缺血监测和QT间期监测的基本知识。网络教学具有内容标准化、使用灵活、实践环节和测试环节反馈及时等优点。使用模拟来测试技能使我们的计划具有创新性。在临床领域实施和维持变革的战略包括加强教育，激励措施，以及在每个单位指定冠军，他们将积极促进实践标准的实施。统计分析将说明医院一级的集群内相关性。大多数结果是分类的，有2个级别，而知识和技能得分是连续的。对于分类结局，将考虑两种方法：使用广义估计方程方法和扩展的Mantel-Haenszel交叉制表方法（按聚类分层）补充聚类内相关性的logistic回归模型。对于连续性结局，将使用混合模型通过分层线性模型解释集群内相关性。我们制定了新的实践标准，以改善医院心电图监测。我们期望改进的ECG监测将导致更准确的诊断和更及时的治疗，这将为患者带来更好的结果。公共卫生相关性：本研究的目的是测试实施新的实践标准心电图（ECG）监测护士的知识和技能，护理质量和病人的结果的影响。如果实践标准的实施与护理质量和患者结局的改善相关，则有可能改善数百万住院期间需要连续ECG监测的患者的护理和结局。

DESCRIPTION (provided by applicant): Despite advances in hospital electrocardiographic (ECG) monitoring technology, monitoring practices are inconsistent and often inadequate. We recently published new practice standards for ECG monitoring. The primary purpose of our proposed 5-year multisite randomized clinical trial, which is guided by the knowledge transfer framework, is to test the effect of implementing these standards on nurses' knowledge and skills, quality of care, and patient outcomes. We will also explore the sustainability of effects in the experimental group and the effect of the delayed intervention in the control group. We expect that increased knowledge and skills of nurses will lead to enhanced quality of care, which will result in improved outcomes for patients. Units serving cardiac patients in 16 hospitals will participate. Hospitals will be randomized to the experimental or control group after baseline measures of knowledge and skills, quality of care, and patient outcomes are obtained. The intervention will include ECG monitoring education and strategies to implement and sustain change. The education will be Web-based and include 4 modules: essentials of ECG monitoring, arrhythmia monitoring, ischemia monitoring, and QT interval monitoring. The standardization of content, flexibility of use, immediate feedback in both practice and testing sections are advantages of Web-based education. The use of simulations to test skills makes our program innovative. The strategies to implement and sustain change in the clinical area include reinforcement of education, incentives, and the designation of champions on each unit who will actively promote the implementation of the practice standards. Statistical analyses will account for intra-cluster correlation at the hospital level. Most outcomes are categorical with 2 levels, whereas knowledge and skill scores are continuous. For categorical outcomes, two approaches will be considered: logistic regression models complemented with intra-cluster correlation using generalized estimating equations methods and extended Mantel-Haenszel cross-tabulation methods stratifying by cluster. For continuous outcomes, mixed modeling will be used to account for intra-cluster correlation through hierarchical linear models. We developed the new practice standards to improve hospital ECG monitoring. We expect that improved ECG monitoring will result in more accurate diagnosis and more timely treatment, which will lead to better outcomes for patients. PUBLIC HEALTH RELEVANCE: The purpose of this study is to test the effect of implementing new practice standards for electrocardiographic (ECG) monitoring on nurses knowledge and skills, quality of care, and patient outcomes. If implementation of the practice standards is associated with improvement in quality of care and patient outcomes, then there is the potential for improved care and outcomes for the literally millions of patients who require continuous ECG monitoring while hospitalized.