一个内科手术远程医疗计划,以改善外科手术期间的质量措施:ACTFAST-3随机临床试验
Christopher R King1, Stephen Gregory1, Bradley A Fritz1
1Department of Anesthesiology, Washington University School of Medicine in St Louis, St Louis, Missouri.
JAMA network open
|September 22, 2023
概括
这项研究发现,实时手术内远程医疗决策支持并没有改善手术后低温或高血糖率的手术患者. 需要进一步优化工作流程,以便远程医疗能够影响有针对性的临床措施.
科学领域:
- 麻醉学 麻醉学
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
背景情况:
- 远程医疗用于临床决策支持在医疗保健中越来越多地被采用.
- 它在改善手术内护理方面的有效性在很大程度上尚未评估.
- 这项研究通过评估手术期间的新型远程医疗干预来弥补这一差距.
研究的目的:
- 试点和评估一个实时的手术内远程医疗决策支持计划.
- 要确定干预措施是否可以减少术后低温和高血糖.
- 评估外科手术期间其他护理质量措施.
主要方法:
- 一个单一中心的试点随机临床试验 (ACTFAST-3) 涉及26,254名成年手术患者.
- 患者被随机分配到常规护理或远程医疗增强护理 (麻醉学控制塔).
- 该干预涉及从麻醉临床医生团队的远程监控和决策支持.
主要成果:
- 干预组和对照组之间在避免术后高血糖症或低温症方面没有显著差异.
- 在干预组中,糖尿病患者的手术内血糖测量增加.
- 二级结局,包括低血压和麻醉过度使用,没有显著差异.
结论:
- 在远程医疗增强护理和常规护理之间,麻醉护理质量指标没有显著差异.
- 目前的远程医疗干预没有明显影响针对性的手术内护理实践.
- 为未来的远程医疗计划推简化临床决策支持和工作流程,以实现可衡量的改进.
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