急性护理执业护士采用结果管理方法护理神经科学患者的效果。

Effect of an outcomes-managed approach to care of neuroscience patients by acute care nurse practitioners.

作者信息

Russell Dale, VorderBruegge Mary, Burns Suzanne M

机构信息

Neuroscience Service Center, University of Virginia Health System, Charlottesville, USA.

出版信息

Am J Crit Care. 2002 Jul;11(4):353-62.

PMID:12102436

Abstract

OBJECTIVE

To improve clinical and financial outcomes for neuroscience patients by using an "outcomes-managed" model of care delivery and 2 acute care nurse practitioners as outcomes managers.

METHODS

Baseline data from the year before implementation of the care model were compared with data from the first 6 months of implementation. A random list of 122 adult patients admitted to the neuroscience intensive care unit or the acute care neurosurgery unit of a university teaching hospital between January and December 1998 was generated to provide the baseline data. The prospective sample included 402 patients admitted to either unit during the first 6 months of the project (January through June 1999). The acute care nurse practitioners used an evidence-based multidisciplinary plan of care to manage all patients.

RESULTS

No differences were found in age, sex, or ethnicity between groups. Patients managed by acute care nurse practitioners had significantly shorter overall length of stay (P = .03), shorter mean length of stay in the intensive care unit (P < .001), lower rates of urinary tract infection and skin breakdown (P < .05), and shorter time to discontinuation of the Foley catheter and mobilization (P <.05). The outcomes-managed group was hospitalized 2306 fewer days than the baseline group, at a total cost savings of $2,467328.

CONCLUSIONS

Clinical and financial outcomes are improved significantly by identifying patients at risk, monitoring for complications, and having acute care nurse practitioners manage the patients.

摘要

目的

通过采用“结果管理”的护理模式并由2名急症护理执业护士担任结果管理者，改善神经科学患者的临床和财务结局。

方法

将护理模式实施前一年的基线数据与实施后前6个月的数据进行比较。生成了一份1998年1月至12月期间入住一所大学教学医院神经科学重症监护病房或急性护理神经外科病房的122名成年患者的随机名单，以提供基线数据。前瞻性样本包括该项目前6个月（1999年1月至6月）期间入住这两个病房的402名患者。急症护理执业护士采用基于证据的多学科护理计划来管理所有患者。

结果

两组在年龄、性别或种族方面未发现差异。由急症护理执业护士管理的患者总体住院时间显著缩短（P = 0.03），在重症监护病房的平均住院时间缩短（P < 0.001），尿路感染和皮肤破损发生率较低（P < 0.05），拔除导尿管和开始活动的时间缩短（P < 0.05）。结果管理组的住院天数比基线组少2306天，总成本节省2467328美元。