通过每日循环检查清单,目标设定和临床医生促使的质量改善干预对重症患者死亡率的影响:随机临床试验
, Alexandre B Cavalcanti1, Fernando Augusto Bozza2
1Research Institute, HCor-Hospital do Coração, São Paulo, Brazil.
JAMA
|April 27, 2016
概括
在重症监护室使用检查清单和设定目标的质量改善干预措施没有降低患者死亡率. 虽然一些护理过程有所改善,但整体住院死亡人数在各组之间仍然相似.
科学领域:
- 危急护理医学
- 质量提升科学
- 医疗服务研究
背景情况:
- 检查清单和重症监护室 (ICU) 的日常目标设定等质量改善干预措施的有效性仍然不确定.
- 为了评估旨在改善重症成人护理和治疗结果的多方面干预措施,进行了一项研究.
研究的目的:
- 确定多方面的质量改善干预措施是否可以降低重症成人住院死亡率.
- 评估干预对各种次要结果的影响,包括遵守护理流程和患者安全环境.
主要方法:
- 一项涉及118名巴西ICU的两阶段研究:第一阶段 (观察) 收集了基线数据,第二阶段 (集群随机试验) 将ICU分配给干预或常规护理.
- 干预包括每天的检查清单,多学科回合的目标设定,以及临床医生对11个护理过程的提示.
- 使用后勤回归分析了住院死亡率 (主要结果),其次要结果包括过程遵守和安全气候.
主要成果:
- 干预组 (32. 9%) 和常规护理组 (34. 8%) 在住院死亡率上没有显著差异.
- 干预组在20个次要结果中的6个显著改善,包括使用低潮量,避免重度镇静,以及改善团队合作和患者安全感.
- 对于剩余的14个次要结果,包括ICU死亡率,感染率和停留时间,没有发现显著差异.
结论:
- 多方面的质量改善干预措施,包括每日检查清单,目标设定和临床医生的提示,并没有减少巴西重症监护室重症患者的住院死亡率.
- 虽然该干预措施对某些护理过程和安全感受产生了积极影响,但对死亡率的整体影响并不显著.
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