Sakallaris B R, Halpin L S, Knapp M, Sheridan M J
APACHE Medical Systems/National Health Advisors, McLean, VA, USA.
Crit Care Nurse. 2000 Apr;20(2):50-5, 59-63, 65-8.
Early data from this project suggest that the RABBIT program fulfilled the process improvement goals of decreasing costs of cardiac surgery and maintaining high quality. Decreased cost was achieved by decreasing time to extubation and decreasing length of stay in the ICU and the total length of stay in the hospital. The cost savings were achieved without compromising the quality of care, which was assessed by measuring rates of readmission to the ICU and to the hospital and by surveying patients about their level of satisfaction. The success of the RABBIT program can be attributed to several factors. First, members of the cardiac surgery quality improvement team worked well together to solve problems and overcome obstacles, particularly after the pilot program. Second, naming the program helped to motivate staff, physicians, and patients. Outcome data was shared with the staff quarterly, and successes were celebrated. Finally, the use of a facilitator early in the process to establish the process with the surgeons and the staff was invaluable. Opportunities for continued improvement include resolving operational difficulties related to availability of beds and staffing, continuing work with physicians in changing practice patterns, increasing efficiency in scheduling operating rooms, and adjusting the preoperative education provided to patients and their families about the length of stay to expect. Quarterly outcome analysis continues, with reports to the cardiac surgery quality improvement team. The team continues to explore creative solutions to the aforementioned issues, as the goal of having 25% of patients who undergo cardiac surgery be transferred to the CTU on the day of surgery has remained elusive.
该项目的早期数据表明，“兔子”计划实现了降低心脏手术成本并维持高质量的流程改进目标。通过缩短拔管时间、缩短重症监护病房（ICU）住院时间以及缩短医院总住院时间，实现了成本降低。在不影响护理质量的情况下实现了成本节约，护理质量通过测量ICU和医院的再入院率以及调查患者满意度来评估。“兔子”计划的成功可归因于几个因素。首先，心脏手术质量改进团队的成员共同努力解决问题、克服障碍，尤其是在试点项目之后。其次，为该计划命名有助于激励工作人员、医生和患者。结果数据每季度与工作人员共享，并庆祝取得的成功。最后，在流程早期使用协调员与外科医生和工作人员确定流程非常宝贵。持续改进的机会包括解决与床位供应和人员配备相关的运营困难、继续与医生合作改变执业模式、提高手术室排班效率，以及调整向患者及其家属提供的关于预期住院时间的术前教育。每季度继续进行结果分析，并向心脏手术质量改进团队报告情况。该团队继续探索针对上述问题的创造性解决方案，因为让25%接受心脏手术的患者在手术当天转至心脏过渡病房（CTU）这一目标仍难以实现。
