Hatler Carol W, Mast Deanna, Corderella Jeannie, Mitchell Gina, Howard Kathleen, Aragon Jackie, Bedker Deborah
Department of Nursing, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
Am J Crit Care. 2006 Nov;15(6):549-55.
Although the value of evidence-based practice may seem obvious, the process needed to produce more effective delivery of evidence-based healthcare is not obvious. Furthermore, the continuing escalation of healthcare costs fuels the desire of providers and consumers to undertake only those treatments that have benefit. One way to effect necessary changes in healthcare organizations is through focused, interdisciplinary, collaborative projects related to evidence-based practice.
To reduce rates of ventilator-associated pneumonia and catheter-related bloodstream infection in patients in the medical intensive care unit of a large, urban tertiary referral hospital in the Southwest.
The theory of planned behavior served as the basis for providing staff members with research-based, easily controllable strategies that "fit" with the usual methods of care delivery. Implementation of the strategies and data collection were accomplished through routine rounds on patients and regular reporting of objective information.
During a 15-month period, use of the selected strategies resulted in a 54% reduction in ventilator-associated pneumonia, a 78% reduction in catheter-related bloodstream infections, and a 18% reduction in mean length of stay in the unit. Use of a multidisciplinary, environmentally tailored approach to concerns about patients' care resulted in estimated cost savings of 1.0 million US dollars to 2.3 million US dollars.
Early, consistent communication about the project's rationale, expected behavior, and outcomes enhanced the manageability and effectiveness of this change in an adult intensive care unit.
尽管循证实践的价值似乎显而易见，但实现更有效的循证医疗服务所需的过程却并不明晰。此外，医疗成本的持续攀升促使医疗服务提供者和消费者只选择那些有益的治疗方法。在医疗机构中实现必要变革的一种方法是通过开展与循证实践相关的重点突出、跨学科的协作项目。
降低美国西南部一家大型城市三级转诊医院内科重症监护病房患者的呼吸机相关性肺炎和导管相关血流感染发生率。
计划行为理论为向工作人员提供基于研究且易于控制的策略奠定了基础，这些策略与常规护理方法 “相契合”。通过对患者的常规查房和客观信息的定期报告来实施这些策略并收集数据。
在15个月的时间里，采用选定的策略使呼吸机相关性肺炎的发生率降低了54%，导管相关血流感染的发生率降低了78%，该科室的平均住院时间缩短了18%。采用多学科、根据环境量身定制的方法来处理患者护理问题，估计节省了100万至230万美元的成本。
尽早、持续地就项目的基本原理、预期行为和结果进行沟通，提高了成人重症监护病房这一变革的可管理性和有效性。
