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，往往不充分。我们最近发布了新的心电监护实践标准。我们提出的以知识转移框架为指导的5年多地点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、护理质量和患者预后的影响。我们还将探讨实验组效果的可持续性以及对照组延迟干预的效果。我们期望，护士知识和技能的提高将提高护理质量，从而改善患者的治疗效果。16家医院为心脏病患者服务的单位将参与。在获得知识和技能、护理质量和患者预后的基线测量后，医院将随机分为实验组或对照组。干预措施将包括心电监护教育和实施和维持变革的战略。课程将以网络为基础，包括4个模块：心电图监测要领、心律失常监测、缺血监测和QT间期监测。内容的标准化、使用的灵活性、实践部分和测试部分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课程具有创新性。实施和维持临床领域变革的战略包括加强教育、激励措施和在每个单位指定积极推动实施实践标准的冠军。统计分析将解释医院一级的集群内相关性。大多数结果是2级的分类，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：使用广义估计方程方法补充聚类内相关性的逻辑回归模型和按聚类分层的扩展Mantel-Haenszel交叉表法。对于连续的结果，混合建模将通过层次线性模型来解释簇内相关性。我们制定了新的实践标准，以提高医院心电监护水平。我们希望通过心电图监测的改进，能够更准确地诊断和及时地治疗，从而为患者带来更好的预后。公共卫生相关性：本研究的目的是检验实施新的心电图监测实践标准对护士知识和技能、护理质量和患者预后的影响。如果实践标准的实施与护理质量和患者预后的改善有关，那么对于数百万在住院期间需要持续心电图监测的患者来说，就有可能改善护理和预后。

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.