建立一个国家质量改进过程在心肺旁路术期间的氧气输送指数
Alfred H Stammers1, Jeffrey B Chores1, Eric A Tesdahl1
1Medical Department, SpecialtyCare, Brentwood, TN, USA.
Perfusion
|August 26, 2023
概括
在心肺绕道术 (CPB) 期间的向氧气输送使用质量改进过程显著改善. 这种方法将氧气输送指数 (DO2i) 确定为关键绩效指标,提高了患者的治疗结果.
科学领域:
- 心血管外科心血管外科
- 输液科学是什么意思 输液科学
- 改善医疗保健的质量
背景情况:
- 在心肺绕道 (CPB) 过程中,有针对性的氧气输送对于患者的治疗结果至关重要,尤其是在预防急性损伤方面.
- 尽管它具有公认的重要性,但在多个机构中广泛采用仍然是有限的.
- 需要一种标准化的方法来有效地实施和监测目标氧气输送.
研究的目的:
- 描述一种质量改善 (QI) 流程的开发和实施,用于在美国医院的CPB期间有针对性的氧气输送.
- 建立氧气输送指数 (DO2i) 作为监测氧气输送的关键绩效指标 (KPI).
- 确定在CPB期间实现目标DO2i水平的障碍和促进因素.
主要方法:
- 开发了一个系统的QI流程,使用DO2i作为一个KPI.
- 文献审查确定了DO2i (272毫升/分钟/米2) 的目标底值和DO2i在曲线下面的区域 (AUC) 截止值 (632).
- 来自91家医院和11,165个CPB程序 (2020年1月至2022年12月) 的数据使用仪表板和后勤回归收集和分析. 一项调查发现了障碍.
主要成果:
- 每月超过目标的DO2i测量的比例在60.5%至78.4% (平均70.8%) 之间.
- 后勤回归显示了在7个月内实现目标DO2i (p < .001) 的显著积极趋势,成功率为73.8%.
- 确定的主要障碍是无法改善CPB流量和限制性红细胞输血政策.
结论:
- 在CPB期间,使用DO2i作为KPI,以最低水平的氧气输送为目标,在结构化QI过程中是可行的和有效的.
- 在QI过程中,在实现目标DO2i水平方面,统计学上显著改善.
- 解决已识别的障碍,例如CPB流量和输血政策,对于进一步优化至关重要.
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