Nurse-led implementation of ETAT plus is associated with reduced mortality in a children's hospital in Freetown, Sierra Leone
Nurse-led implementation of ETAT plus is associated with reduced mortality in a children's hospital in Freetown, Sierra Leone
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DOI：
10.1080/20469047.2020.1713610
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发表时间：
2020-01-18
影响因子：
1.8
通讯作者：
Hands, Christopher
中科院分区：
文献类型：
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作者：
Hands, Sandra;Verriotis, Madeleine;Hands, Christopher
背景：在塞拉利昂埃博拉病毒病(埃博拉病毒病)流行之后，二级护理机构面临入院人数增加的问题，可用于评估和治疗患者的医务人员寥寥无几。这导致医院门诊部的等待时间很长。这项研究是在2014-2015年埃博拉埃博拉疫情之后不久的儿童医院(塞拉利昂的三级儿科医院)期间，在OLA的门诊部进行的。目的：这项业务计划数据的回顾分析旨在评估医疗和护理人员之间的质量改进方法和任务分担是否改善了分诊的质量和护理的及时性。方法：对所有门诊工作人员进行为期4周的培训，并进行6个月的岗位督导和支持。成功完成课程的护士被赋予对病人的初步评估以及开处方和给予初步治疗的责任。在干预前、干预开始后3个月和6个月收集数据。所有在周一至周五上午8点至14点到医院就诊的儿童都被包括在内。将门诊护士的分诊评估与有临床经验的观察者进行的分诊评估进行比较，并记录每个儿童被分诊、评估和给予初步治疗所需的时间。结果：在干预0~6个月期间，分诊护士对急症体征的检测率从30%提高到100%，优先体征的检测率从34%提高到100%。对于出现紧急体征的儿童，分诊和全面评估之间的中位时间从干预前的57分钟改善到3个月时的17分钟和6个月时的5分钟(p<；0.0005)。在同一组中，从分诊到第一次抗生素或抗疟疾治疗的中位时间从干预前的220min改善到3个月时的40分钟和6个月时的18分钟(p=0.006)。结论：结果表明，在适当的培训和支持下，将对患病儿童的紧急评估和治疗扩大到西非医院的护理人员，可以提高对出现严重疾病症状的儿童进行分诊的准确性和评估和治疗的时间。
Background: In the wake of the Ebola virus disease (EVD) epidemic in Sierra Leone, secondary care facilities faced an increase in admissions with few members of medical staff available to assess and treat patients. This led to long waiting times in hospital outpatient departments. The study was undertaken in the outpatient department of Ola During Children's Hospital (the tertiary paediatric hospital for Sierra Leone) in the period immediately following the EVD epidemic of 2014-2015. Aims: This retrospective analysis of operational programme data aimed to assess whether a quality-improvement approach and task-sharing between medical and nursing staff improved the quality of triage and the timeliness of care. Methods: All staff working in the outpatient department were offered a 4-week training course, followed by on-the-job supervision and support for 6 months. Nurses who successfully completed the course were given responsibility for the initial assessment of sick patients and for prescribing and giving initial treatment. Data were collected at three points: before intervention and at 3 and 6 months after initiation of the intervention. All children presenting to the hospital for medical attention between 0800 and 1400 Monday to Friday were included. Triage assessment by the outpatient nurse was compared to that made by a clinically experienced observer, and the time taken for each child to be triaged, assessed and given initial treatment was recorded. Results: Between months 0 and 6 of the intervention, detection of emergency signs by the triage nurse improved from 30% to 100%, and detection of priority signs improved from 34% to 100%. For children presenting with emergency signs, the median time between triage and full assessment improved from 57 minutes before intervention to 17 minutes at 3 months and 5 minutes at 6 months (p < 0.0005). For the same group, median time between triage and first antibiotic or antimalarial treatment improved from 220 minutes before intervention to 40 minutes at 3 months and 18 minutes at 6 months (p = 0.006). Conclusion: The results indicate that, with appropriate training and support, extending the emergency assessment and treatment of sick children to nursing staff in West African hospitals may improve the accuracy of triage and the time to assessment and treatment of children presenting with signs of serious illness.