护理中心气管切除组:多学科合作,改善复杂患者的生存率
Joana Silva Machry1, Julia Krzyzewski2, Courtney Ward2
1Division of Neonatology, Maternal Fetal & Neonatal Institute at Johns Hopkins All Children's Hospital St. Petersburg, St. Petersburg, FL, USA. jmachry1@jhmi.edu.
概括
在NICU中实施一个多学科的气管切除团队提高了患者的生存率. 这项质量改进倡议证明了可行性,并提高了气管切除术患者的生存率,但没有显著增加气管切除术患者的逗留时间.
科学领域:
- 新生儿重症监护室 (NICU) 的护理.
- 医疗保健中的质量改善 (QI)
- 儿科呼吸系统护理服务
背景情况:
- 气管切除术是新生儿的关键干预,需要长时间的机械通风.
- 优化气管切除术护理对于改善重症婴儿的治疗结果至关重要.
- 建立专门的多学科团队可以提高患者管理和安全.
研究的目的:
- 评估专门的气管切除组对IV级NICU生存率和停留时间 (LOS) 的可行性和影响.
- 评估质量改善策略在治疗气管切除术的新生儿方面的有效性.
- 在新生儿环境中确定成功的气管切除术护理的关键驱动因素.
主要方法:
- 利用计划-做-研究-行动 (PDSA) 循环,针对全球气管切除合作的关键驱动因素.
- 从2017年1月到2022年12月进行多学科,每两个月一次的病床巡视.
- 分析了介入前和之后的住院生存率和住院时间的中位数 (LOS).
主要成果:
- 气管切除术患者的住院生存率显著改善,从66.7%提高到89.7% (p=0.03).
- 中位数LOS在基线和QI期间之间没有显著差异 (237比217天;p=0.9).
- 患有支气管肺形症 (BPD) 患者的中位数 LOS (332.5 vs. 248天; p=0.02) 增加,QI后气管炎/肺炎的发病率更高.
结论:
- 多学科的气管切除组方法是可行的,并提高了NICU患者的存活率.
- 质量指数倡议提高了生存率,但没有持续增加整体LOS.
- 未来的QI努力应集中在减轻手术后感染性并发症,特别是在BPD患者中.
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