Effect of an outcomes-managed approach to care of neuroscience patients by acute care nurse practitioners.
Effect of an outcomes-managed approach to care of neuroscience patients by acute care nurse practitioners.
复制标题
急症护理护士采用结果管理方法护理神经科患者的效果。
DOI：
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发表时间：
2002
影响因子：
2.7
通讯作者：
S. Burns
中科院分区：
文献类型：
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作者：
D. Russell;Mary VorderBruegge;S. Burns
目的
通过使用“结果管理”的护理交付模式和2名急性护理执业护士作为结果管理者，改善神经科学患者的临床和财务结果。
方法
将实施护理模式前一年的基线数据与实施前6个月的数据进行比较。1998年1月至12月间，随机抽取了122名在某大学教学医院神经科学重症监护室或神经外科急症室接受治疗的成人患者，以提供基线数据。前瞻性样本包括402名患者在该项目的前6个月（1999年1月至6月）入住任何一个单位。急诊护理执业护士采用循证多学科护理计划来管理所有患者。
结果
两组之间在年龄、性别或种族方面没有发现差异。由急诊护理专业护士管理的患者总体住院时间显著缩短（P = 0.03），在重症监护室的平均住院时间缩短（P <0.001），尿路感染和皮肤破裂的发生率降低（P <0.05），停用Foley导管和动员的时间缩短（P <0.05）。结果管理组住院天数比基线组少2306天，总费用节省2467328美元。
结论
通过识别风险患者，监测并发症，并让急性护理护士管理患者，临床和财务结果得到显着改善。
OBJECTIVE
To improve clinical and financial outcomes for neuroscience patients by using an "outcomes-managed" model of care delivery and 2 acute care nurse practitioners as outcomes managers.
METHODS
Baseline data from the year before implementation of the care model were compared with data from the first 6 months of implementation. A random list of 122 adult patients admitted to the neuroscience intensive care unit or the acute care neurosurgery unit of a university teaching hospital between January and December 1998 was generated to provide the baseline data. The prospective sample included 402 patients admitted to either unit during the first 6 months of the project (January through June 1999). The acute care nurse practitioners used an evidence-based multidisciplinary plan of care to manage all patients.
RESULTS
No differences were found in age, sex, or ethnicity between groups. Patients managed by acute care nurse practitioners had significantly shorter overall length of stay (P = .03), shorter mean length of stay in the intensive care unit (P < .001), lower rates of urinary tract infection and skin breakdown (P < .05), and shorter time to discontinuation of the Foley catheter and mobilization (P <.05). The outcomes-managed group was hospitalized 2306 fewer days than the baseline group, at a total cost savings of $2,467328.
CONCLUSIONS
Clinical and financial outcomes are improved significantly by identifying patients at risk, monitoring for complications, and having acute care nurse practitioners manage the patients.