Horowitz Carol R, Chassin Mark R
Department of Health Policy, Mount Sinai School of Medicine, New York, New York 10029, USA.
Am J Med. 2002 Oct 1;113(5):379-83. doi: 10.1016/s0002-9343(02)01233-0.
Although many hospitals have reported attempts to reduce length of stay for patients hospitalized with community-acquired pneumonia, few have included efforts to educate patients to prepare them for earlier discharges. We aimed to improve patients' knowledge about pneumonia and their experiences with inpatient care as part of a multifaceted intervention that included attempts to reduce unnecessary time on intravenous antibiotics and length of hospital stay.
We developed guidelines for the appropriate duration of intravenous antibiotics in patients with community-acquired pneumonia and collected baseline data retrospectively on patients discharged from October 1996 through April 1997. We surveyed these patients to assess knowledge and experience with care. Beginning in July 1997, we conducted a series of physician and nurse educational interventions (lectures, feedback of performance data, one-on-one education by peers). Patients received education about pneumonia from their nurses and a specially developed educational brochure. Following the interventions, we collected clinical and survey data on patients with pneumonia discharged from October 1997 through April 1998.
Among patients who responded to the survey (163 in the preintervention period; 114 in the postintervention period), fewer reported that no one went out of the way to help them (preintervention, 37% [n = 60]; postintervention, 6% [n = 7]; P = 0.001), more reported that they received all the information they needed to recover (75% [n = 122] vs. 94% [n = 107], P = 0.02), and more reported that they were told about danger signals of relapse (46% [n = 75] vs. 60% [n = 68], P = 0.03). Mean (+/- SD) time on intravenous antibiotics decreased from 5.0 +/- 3.7 days to 4.3 +/- 3.3 days (P = 0.04).
The interventions improved patients' knowledge and experiences with care, while decreasing time on intravenous antibiotics.
尽管许多医院都报告了为缩短社区获得性肺炎住院患者的住院时间所做的努力，但很少有医院将对患者进行教育以使其为提前出院做好准备纳入其中。作为一项多方面干预措施的一部分，我们旨在提高患者对肺炎的认知以及他们的住院护理体验，该干预措施包括减少静脉使用抗生素的不必要时间和缩短住院时间。
我们制定了社区获得性肺炎患者静脉使用抗生素的适当疗程指南，并回顾性收集了1996年10月至1997年4月出院患者的基线数据。我们对这些患者进行了调查，以评估他们的知识和护理体验。从1997年7月开始，我们开展了一系列针对医生和护士的教育干预措施（讲座、绩效数据反馈、同行一对一教育）。患者从护士和一本专门编写的教育手册中获得了有关肺炎的教育。干预措施实施后，我们收集了1997年10月至1998年4月出院的肺炎患者的临床和调查数据。
在对调查做出回应的患者中（干预前163例；干预后114例），更少的患者报告没有人特意帮助他们（干预前，37%[n = 60]；干预后，6%[n = 7]；P = 0.001），更多的患者报告他们获得了康复所需的所有信息（75%[n = 122]对94%[n = 107]，P = 0.02），并且更多的患者报告他们被告知复发的危险信号（46%[n = 75]对60%[n = 68]，P = 0.03）。静脉使用抗生素的平均（±标准差）时间从5.0±3.7天降至4.3±3.3天（P = 0.04）。
这些干预措施提高了患者的知识水平和护理体验，同时减少了静脉使用抗生素的时间。
