在重症监护病房环境中提高康复质量：实施质量改进模型。

Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model.

机构信息

Division of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.

出版信息

Top Stroke Rehabil. 2010 Jul-Aug;17(4):271-81. doi: 10.1310/tsr1704-271.

DOI:10.1310/tsr1704-271

PMID:20826415

Abstract

OBJECTIVE

There are barriers to providing early physical medicine and rehabilitation (PM&R) in the intensive care unit (ICU). We present a specific model for undertaking quality improvement (QI) projects and a case study focused on QI for early PM&R in the ICU.

METHODS

The QI project was undertaken using a 4-step model: (1) summarizing the evidence, (2) identifying barriers, (3) establishing performance measures, and (4) ensuring patients receive the intervention. To evaluate the application and outcomes of this model, we present data collected during a 4-month QI period versus an immediately preceding 3-month control period.

RESULTS

Deep sedation was a major barrier to early PM&R that was addressed in the QI project. Compared to the control period, there was a decrease in medical ICU (MICU) days with any benzodiazepine use (73% vs 96% of days, P = .03) and narcotic use (77% vs 96%, P = .05) and improved delirium status (MICU days without delirium, 53% vs 21%, P = .003). In addition, more QI patients had physical therapy consultations (93% vs 59%, P = .004) and greater number of rehabilitation treatments with higher functional mobility (treatments involving sitting or greater mobility, 78% vs 56%, P = .03). Hospital data for the QI period demonstrated a decrease in average length of stay in the MICU (4.9 vs 7.0 days, P = .02) and hospital (14.1 vs 17.2, P = .03) compared to the prior year.

CONCLUSION

A structured QI model can be applied to implementation of early PM&R in the ICU resulting in markedly improved delirium status, delivery of PM&R, functional mobility, and length of stay.

摘要

目的

在重症监护病房（ICU）提供早期物理医学与康复（PM&R）存在障碍。我们提出了一个专门的质量改进（QI）项目模型，并以 ICU 中早期 PM&R 的 QI 为案例研究。

方法

QI 项目采用了 4 步模型：（1）总结证据，（2）确定障碍，（3）建立绩效衡量标准，以及（4）确保患者接受干预。为了评估该模型的应用和结果，我们展示了在 4 个月的 QI 期间与之前 3 个月的对照期间收集的数据。

结果

深度镇静是早期 PM&R 的一个主要障碍，这在 QI 项目中得到了解决。与对照期相比，使用任何苯二氮䓬类药物（73%对 96%的天数，P =.03）和麻醉性镇痛药（77%对 96%，P =.05）的 ICU 天数减少，谵妄状态得到改善（无谵妄的 ICU 天数，53%对 21%，P =.003）。此外，更多的 QI 患者接受了物理治疗咨询（93%对 59%，P =.004），并接受了更多的康复治疗，具有更高的功能移动性（涉及坐起或更高移动性的治疗，78%对 56%，P =.03）。QI 期间的医院数据显示，与前一年相比，重症监护病房（4.9 天对 7.0 天，P =.02）和医院（14.1 天对 17.2 天，P =.03）的平均住院时间缩短。