重症患者の死亡率に対する毎日のラウンドチェックリスト,目標設定,臨床医による品質改善介入の効果:ランダム化臨床試験
, Alexandre B Cavalcanti1, Fernando Augusto Bozza2
1Research Institute, HCor-Hospital do Coração, São Paulo, Brazil.
JAMA
|April 27, 2016
まとめ
チェックリストと集中治療室での目標設定による品質改善の介入は,患者の死亡率を低下させなかった. 治療の過程は改善したが,病院での死亡はグループごとに同じだった.
科学分野:
- クリティカル ケア 医療
- 品質向上 科学
- 医療サービス研究
背景:
- チェックリストや集中治療室 (ICU) での毎日の目標設定のような品質改善の介入の有効性は依然として不確実です.
- 重症の成人のケアと治療結果を改善することを目的とした多面的な介入を評価する研究が行われました.
研究 の 目的:
- 多面的な品質改善の介入が 病院での死亡率を減らすことができるかどうかを判断する
- 介護プロセスと患者の安全環境の遵守を含む様々な二次結果に対する介入の影響を評価する.
主な方法:
- ブラジルのICU118人を対象とした2段階の研究:第1段階 (観察) はベースラインデータを収集し,第2段階 (クラスターランダム化試験) は,ICUを介入またはルーティンケアに割り当てました.
- 介入には,毎日チェックリストを作成し,多学科のラウンドで目標を設定し,臨床医が11のケアプロセスを提示しました.
- 病院内での死亡率 (主要アウトカム) は,物流回帰を用いて分析され,次要アウトカムには,プロセス遵守と安全環境が含まれていた.
主要な成果:
- 介入群 (32. 9%) と通常の治療群 (34. 8%) の間で,入院死亡率の有意な差は認められなかった.
- 介入グループは,低潮量使用,重度の鎮静を避ける,チームワークと患者の安全感の向上を含む,二次的アウトカムのうち6つで有意な改善を示しました.
- ICUでの死亡率,感染率,入院期間など,残りの14の二次的アウトカムでは有意な差異は認められなかった.
結論:
- 日々のチェックリスト,目標設定,臨床医の誘導を含む多面的な品質改善の介入は,ブラジルのICUの重症患者の入院死亡率を減少させませんでした.
- この介入は特定のケアプロセスと安全感に好ましい影響を及ぼしたが,死亡率に対する全体的な影響は有意ではなかった.
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