在由呼吸治疗师领导的单个儿科重症监护病房中提高非计划性输出率
Christy L Thomas1, Jordan M Unlap1, Caleb R Watson1
1Ms. Thomas, Unlap, Watson, Jones, and Park are affiliated with the Department of Respiratory Care Services, Children's of Alabama, Birmingham, Alabama, USA.
Respiratory care
|October 31, 2025
概括
通过质量改善干预措施,重症儿童的非计划性输卵减少了72.5%. 这种持续减少儿科重症监护病房突显了专门的冠军和确立的预防捆绑的重要性.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 提高质量 提高科学 提高质量
- 患者安全 患者安全
背景情况:
- 危急病患儿童的非计划性输出管 (UE) 会导致显著的发病率,死亡率和医疗费用增加.
- 尽管多中心成功实施了预防包,但UE率仍然是可预防伤害的常见来源.
- 现有的预防策略需要进一步加强,以实现可持续的减少.
研究的目的:
- 在儿科重症监护室 (PICU) 中,每100个侵入性通风日减少50%的UE.
- 在五年期间 (2020-2025) 实施和评估多项质量改善干预措施.
- 评估干预措施对患者结果和平衡措施的影响.
主要方法:
- 一个纵向的,多干预质量改进项目,在一个单一的四级护理 PICU.
- 利用计划-研究-做-行动 (PDSA) 周期来推动代改进.
- 建立在最初实施的患者安全网络解决方案UE预防包的基础上,拥有专门的QI呼吸治疗师.
主要成果:
- 实现了UE/100入侵通风日减少72.5%,满足了从0.58到0.16.0的中心线移动标准.
- 从2023年第一季度到2025年第二季度维持了降低的UE率,而不会对诸如侵入性通风持续时间等平衡措施产生不利影响.
- 观察到需要侵入性通风的PICU患者的百分比下降 (42%至33%).
结论:
- 多次干预,由一个专门的冠军驱动,显著降低和持续的UE率在PICU.
- 这项研究证实了建立在既有预防捆绑的基础上,为儿科患者的安全建立预防捆绑的重要性.
- 质量改善举措可以有效地减少可预防的伤害,而不会对其他关键护理指标产生负面影响.
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