Young M P, Gooder V J, Oltermann M H, Bohman C B, French T K, James B C
Critical Care Department, McKay-Dee Hospital Center, Ogden, UT 84403, USA.
Int J Qual Health Care. 1998 Feb;10(1):15-26. doi: 10.1093/intqhc/10.1.15.
To determine the clinical and financial outcomes of a highly structured multidisciplinary care model for patients in an intensive care unit (ICU) who require prolonged mechanical ventilation. The structured model outcomes (protocol group) are compared with the preprotocol outcomes.
Descriptive study with financial analysis.
A twelve-bed medical-surgical ICU in a non-teaching tertiary referral center in Ogden, Utah.
During a 54 month period, 469 consecutive intensive care patients requiring mechanical ventilation for longer than 72 hours who did not meet exclusion criteria were studied.
A multidisciplinary team was formed to coordinate the care of ventilator-dependent patients. Care was integrated by daily collaborative bedside rounds, monthly meetings, and implementation of numerous guidelines and protocols. Patients were followed from the time of ICU admission until the day of hospital discharge.
Patients were assigned APACHE II scores on admission to the ICU, and were divided into eight diagnostic categories. ICU length of stay, hospital length of stay, costs, charges, reimbursement, and in-hospital mortality were measured.
Mortality in the preprotocol and protocol group, after adjustment for APACHE II scores, remained statistically unchanged (21-23%). After we implemented the new care model, we demonstrated significant decreases in the mean survivor's ICU length of stay (19.8 days to 14.7 days, P= 0.001), hospital length of stay (34.6 days to 25.9 days, P=0.001), charges (US$102500 to US$78500, P=0.001), and costs (US$71900 to US$58000, P=0.001).
Implementation of a structured multidisciplinary care model to care for a heterogeneous population of ventilator-dependent ICU patients was associated with significant reductions in ICU and hospital lengths of stay, charges, and costs. Mortality rates were unaffected.
确定一种高度结构化的多学科护理模式对重症监护病房（ICU）中需要长期机械通气患者的临床和财务结局。将结构化模式的结局（方案组）与方案实施前的结局进行比较。
带有财务分析的描述性研究。
犹他州奥格登市一家非教学型三级转诊中心的拥有12张床位的内科-外科ICU。
在54个月期间，对469例连续入住重症监护病房且需要机械通气超过72小时且未符合排除标准的患者进行了研究。
组建了一个多学科团队来协调依赖呼吸机患者的护理。通过每日床边协作查房、每月会议以及实施众多指南和方案来整合护理。从患者入住ICU之时起直至出院之日进行随访。
患者在入住ICU时被分配急性生理与慢性健康状况评分系统（APACHE II）分数，并被分为八个诊断类别。测量ICU住院时长、医院住院时长、费用、收费、报销金额以及院内死亡率。
在对APACHE II分数进行调整后，方案实施前和方案组的死亡率在统计学上保持不变（21%-23%）。在实施新的护理模式后，我们发现存活患者的平均ICU住院时长（从19.8天降至14.7天，P = 0.001）、医院住院时长（从34.6天降至25.9天，P = 0.001）、收费（从102500美元降至78500美元，P = 0.001）和成本（从71900美元降至58000美元，P = 0.001）均显著降低。
实施一种结构化的多学科护理模式来护理依赖呼吸机的不同类型ICU患者，可使ICU和医院住院时长、收费和成本显著降低。死亡率未受影响。
