唤醒和呼吸协调:对实施决定因素的混合方法分析
Griffin H Olsen1, Perry M Gee2, Doug Wolfe1
1Intermountain Healthcare Delivery Institute and.
Annals of the American Thoracic Society
|July 6, 2023
概括
常规自发唤醒和呼吸试验 (SAT/SBT) 的坚持在重症监护室之间有显著差异,全系统坚持仅为21%. 需要实施战略来解决知识差距和工作流程挑战,以改善患者的治疗结果.
科学领域:
- 关键护理医学 关键护理医学
- 实施科学 实施科学
背景情况:
- 常规自发唤醒和呼吸试验协调 (SAT/SBT) 是基于机械呼吸患者的证据.
- 每天遵守SAT/SBT的情况各不相同,影响患者的治疗结果和长时间的机械通风.
- 了解实施决定因素对于改善遵守至关重要.
研究的目的:
- 为了测量15个ICU的每日SAT/SBT使用的变化.
- 确定解释SAT/SBT使用变化的实施决定因素.
- 为提高SAT/SBT遵守率的策略提供信息.
主要方法:
- 解释性,连续的混合方法研究.
- 量化测量SAT/SBT遵守率 (2021年1月至6月).
- 质量半结构面试与55名临床医生在四个不同的地点 (2021年10月至12月).
主要成果:
- 全系统协调的SAT/SBT遵守率为21% (范围为9-68%).
- 临床医生对基于证据的SAT/SBT的知识各不相同.
- 障碍包括工作流协调困难,未定义的协议,缺乏标准化的跟踪,以及与流行病相关的工作量增加.
结论:
- 在综合卫生系统中,协调的SAT/SBT遵守存在实质性的差异.
- 实施策略必须解决知识缺陷,工作流集成和绩效测量.
- 未来的试验应该测试改善SAT/SBT坚持和减少机械通风持续时间的干预措施.
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