Implementation of Practice Standards for ECG Monitoring

描述(由申请人提供)：尽管医院的心电监测技术取得了进步，但监测实践并不一致，而且往往不够充分。我们最近发布了新的心电监护实践标准。我们建议的为期5年的多点随机临床试验的主要目的是在知识转移框架的指导下，测试实施这些标准对护士的知识和技能、护理质量和患者结果的影响。我们还将探讨试验组效果的可持续性和对照组延迟干预的效果。我们预计，护士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家医院的心脏病患者服务单位将参加。在获得知识和技能、护理质量和患者结果的基线测量后，医院将被随机分配到试验组或对照组。干预措施将包括心电监测、教育以及实施和维持变化的战略。教学将基于网络，包括4个模块：心电监护要领、心律失常监护、缺血监护和QT间期监护。内容的标准化、使用的灵活性、练习和测试环节的即时反馈是网络教育的优势。使用模拟来测试技能使我们的计划具有创新性。实施和维持临床领域变革的战略包括加强教育、激励和指定每个单位的冠军，他们将积极推动实践标准的实施。统计分析将考虑医院一级的群组内相关性。大多数结果是绝对的，有两个水平，而知识和技能得分是连续的。对于分类结果，将考虑两种方法：Logistic回归模型和使用广义估计方程方法的组内相关性补充，以及按组分层的扩展Mantel-Haenszel交叉表方法。对于连续的结果，将使用混合建模来通过分层线性模型来解释组内相关性。我们制定了新的实践标准，以提高医院心电监测的水平。我们预计，改进的心电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心电监测实践标准对护士的知识和技能、护理质量和患者结局的影响。如果实践标准的实施与护理质量和患者结果的改善相关，那么就有可能改善数百万住院期间需要持续心电监测的患者的护理和结果。

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.