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风险调整后的累积质量控制图表与重症监护中标准化死亡率的比较
Claudio M Martin1,2,3,4, Fran Priestap5, Raymond Kao5,6,7
1London Health Sciences Centre, Victoria Hospital, London, ON, Canada. cmartin1@uwo.ca.
Canadian journal of anaesthesia = Journal canadien d'anesthesie
|November 7, 2024
概括
经风险调整的p图表通过检测死亡率上升来有效监测重症监护室 (ICU) 的表现. 这些图表显示,与累积和 (CUSUM) 和标准化死亡率 (SMR) 方法相比,灵敏度更高.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 关键护理医学 关键护理医学
- 统计过程控制统计过程控制
背景情况:
- 监测重症监护室 (ICU) 绩效的最佳方法尚不清楚.
- 评估ICU的表现对于患者的安全和护理质量至关重要.
研究的目的:
- 为了比较不同过程控制图的有效性,以检测ICU内风险调整后死亡率的增加.
- 评估标准化死亡率 (SMR),p图表和累计总和 (CUSUM) 图表.
主要方法:
- 利用了加拿大安大略省17个医疗外科ICU的数据 (29,592名患者).
- 在每月间隔创建风险调整的p图表,SMR和CUSUM图表.
- 模拟死亡率增加 (10%,30%,50%),以确定图表灵敏度.
主要成果:
- P图表表现出最高的灵敏度 (88%),用于检测ICU死亡率的模拟增加50%.
- 累积总和 (CUSUM) 图表具有71%的灵敏度,标准化死亡率 (SMR) 图表具有59%的灵敏度.
- 所有方法都表现不佳,模拟死亡率增加较低.
结论:
- 风险调整的p图是常规ICU性能监测的潜在有价值的工具.
- 进一步的研究应该包括与ICU领导人的可用性测试.
- 将这些监测方法应用于其他临床领域需要进行调查.
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