Randomised trial of continuity of nursing care in vascular surgery

无论是在国外（Bruni, hoosier - patty and Hoffman 1996）还是在澳大利亚（Norman, Semmens, Laurence-Brown and Holman，正在审查中），外科医生都越来越意识到需要改善下肢动脉手术患者的预后。与心脏外科手术或乳腺癌等保健改革的其他领域不同，人们对急症设施、社区保健服务和全科医生之间目前的联系能否最佳地协同工作几乎没有信心。外周血管疾病很少被研究。在新南威尔士州，每年约有4200例下肢缺血动脉手术住院病例（AN-DRG 228 - 232），其中大多数是老年男性。本研究汇集了一个多学科的ci团队，包括一名学术护士，两名血管外科医生和一名结果评估专家，对下肢动脉手术患者的护理连续性进行了一项随机试验（n-586）。干预措施包括“病人住院”流程图、持续的术后住院护理评估和工作人员咨询、病人教育出院小册子、病人-家庭护理计划；主动和被动的电话跟进和广泛的全科医生联络。6个月和12个月的盲法结果评估将比较其与仅添加了患者住院流程图的常规护理的差异效果。我们将生成二级证据，证明连续性护理在改善下肢缺血动脉手术患者预后方面的有效性。据我们所知，这将是澳大利亚首例此类疗效试验。

Both overseas (Bruni, Hoosier-Paty and Hoffman 1996) and in Australia (Norman, Semmens, Laurence-Brown and Holman, under review), surgeons have become increasingly aware of the need to improve outcomes for patients undergoing arterial surgery for the lower limb. Unlike other areas of health care reform such as cardiac surgery or breast cancer, there is little confidence that the current links between acute facilities, community-based health services and general practice, work optimally together. Peripheral vascular disease is rarely studied. In NSW, there are about 4200 inpatient episodes for arterial surgery for ischaemia of the lower limb each year (AN-DRG 228 - 232), the majority involving older men. This study brings together a multi-disciplinary team of CIs comprising an academic nurse, two vascular surgeons and an expert in outcomes evaluation to conduct a randomised trial (n-586) of continuity of nursing care for patients admitted for arterial surgery of the lower limb. The intervention is comprised of a 'Patient Stay' Flowchart, continuing postoperative in-patient nursing assessment and staff consultation, Patient Education Discharge Booklet, Patient - Family Care Plan; proactive and reactive telephone follow-up and extensive GP liaison. Blinded outcome evaluation at six and twelve months will compare its differential effectiveness against usual care to which only the Patient Stay' Flowchart has been added. We will generate Level 2 evidence for the effectiveness of continuity of nursing care in improving outcomes for patients undergoing arterial surgery for ischaemia of the lower limb. To our knowledge, this would be the first Australian efficacy trial of its type.