医生人员配置模式和重症患者的临床结果:系统性审查
Peter J Pronovost1, Derek C Angus, Todd Dorman
1Department of Critical Care Medicine, Hopkins University, Baltimore, Md, USA.
JAMA
|November 7, 2002
概括
高强度重症监护室 (ICU) 的医生人员,包括重症监护医生,与较低的患者死亡率和较短的住院时间有关. 这与低强度人员配置模式形成鲜明对比.
科学领域:
- 关键护理医学 关键护理医学
- 医疗保健服务研究 医疗服务研究
- 医疗人员 医疗人员
背景情况:
- 重症监护室 (ICU) 医生人员配置模型表现出显著的变化.
- 不同的ICU医生人员配置水平对患者结果的影响仍然不完全理解.
研究的目的:
- 系统地评估ICU医生人员配置策略与患者治疗结果之间的关联.
- 综合关于人员密集度与死亡率和逗留时间之间的关系的证据.
主要方法:
- 在多个数据库 (MEDLINE,EMBASE,HealthStar,Cochrane Library) 和科学会议摘要中进行了全面的文献搜索.
- 包括的研究是临床临床试验和临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床临床
- 数据提取和质量评估由两位独立审查员进行.
主要成果:
- 高强度的人员 (强度强制或封闭的ICU) 与医院死亡率 (RR 0.71;95% CI,0.62-0.82) 和ICU死亡率 (RR 0.61;95% CI,0.50-0.75) 显著降低.
- 高强度人员配置在13项研究中减少了10项住院时间 (LOS),在18项研究中减少了14项ICU LOS.
- 这些对LOS的积极影响即使在相关研究中进行了案例混合调整后也保持不变.
结论:
- 高强度的ICU医生人员配置模型与改善的患者结果有关,包括减少医院和ICU死亡率.
- 实施高强度人员配置策略可能会导致住院和ICU停留时间减少.
- 有证据支持集中治疗师在重症监护机构参与的好处.
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