麻醉后护理单元的临床路径，以减少住院时间、死亡率和非计划重症监护病房入院率。

A clinical pathway in a post-anaesthesia care unit to reduce length of stay, mortality and unplanned intensive care unit admission.

机构信息

Division of Anaesthesiology, Department of Anaesthesiology, Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.

出版信息

Eur J Anaesthesiol. 2011 Dec;28(12):859-66. doi: 10.1097/EJA.0b013e328347dff5.

DOI:10.1097/EJA.0b013e328347dff5

PMID:21885983

Abstract

CONTEXT

The immediate post-operative period is critical with regard to post-operative outcomes.

OBJECTIVE

To assess the impact of a clinical pathway implemented in a post-anaesthesia care unit on post-operative outcomes.

DESIGN

A retrospective cohort study based on electronic patient records.

SETTING

A post-anaesthesia care unit in a Swiss University Hospital.

PATIENTS

Adult patients after elective and non-elective surgery.

INTERVENTION

Implementation of a clinical pathway with a nurse-driven fast-track programme for uncomplicated patients (systematic use of Aldrete score and systematic discharge without physician) and a physician-driven slow-track programme for complicated patients (systematic handover between operating theatre and post-anaesthesia care unit, and between post-anaesthesia care unit and ward, systematic rounds, systematic use of standardised care for post-operative events, strict discharge criteria).

MAIN OUTCOME MEASURES

Post-anaesthesia care unit length of stay, in-hospital mortality and unplanned admission to the ICU after post-anaesthesia care unit stay.

METHODS

Comparison of the periods before and after implementation using median and interquartile range (IQR) and rates (%).

STATISTICAL ANALYSIS

unpaired Student's t-test, χ test, Wilcoxon rank test. Differences were adjusted through multivariate analyses with linear and logistic regression (level of significance: P < 0.05) and expressed as odds ratio (OR) with 95% confidence interval (95% CI).

RESULTS

After implementation, the median post-anaesthesia care unit length of stay decreased for all patients from 163 min (IQR 103-291) to 148 min (IQR 96-270; P < 0.001); in the American Society of Anaesthesiologists 1-2 patients, it decreased from 152 min (IQR 102-249) to 135 min (IQR 91-227; P < 0.001). In-hospital mortality decreased for all patients from 1.7 to 0.9% [adjusted OR 0.36 (95% CI 0.22-0.59), P < 0.001]. The number of unplanned admissions to the ICU decreased from 113 (2.8%) to 91 (2.1%) [adjusted OR 0.73 (95% CI 0.53-0.99), P = 0.04].

CONCLUSION

A clinical pathway in a post-anaesthesia care unit can significantly reduce length of stay and can improve post-operative outcome.

摘要

背景

术后即刻是影响术后结果的关键时期。

目的

评估在麻醉后护理单元实施临床路径对术后结果的影响。

设计

基于电子患者记录的回顾性队列研究。

地点

瑞士大学医院的麻醉后护理单元。

患者

择期和非择期手术后的成年患者。

干预措施

为非复杂性患者实施护士主导的快速通道计划（系统使用 Aldrete 评分和无需医生即可系统出院）和为复杂性患者实施医生主导的慢速通道计划（手术室和麻醉后护理单元之间、麻醉后护理单元和病房之间的系统交接、系统查房、系统使用标准化术后护理、严格出院标准）。

主要观察指标

麻醉后护理单元的住院时间、院内死亡率以及麻醉后护理单元住院后计划外转入 ICU。

方法

使用中位数和四分位距（IQR）和比率（%）比较实施前后的时间段。

统计分析

未配对学生 t 检验、χ检验、Wilcoxon 秩检验。通过多元线性和逻辑回归分析进行差异调整（显著性水平：P < 0.05），并表示为优势比（OR）及其 95%置信区间（95%CI）。

结果

实施后，所有患者的麻醉后护理单元住院时间中位数从 163 分钟（IQR 103-291）降至 148 分钟（IQR 96-270；P < 0.001）；美国麻醉医师协会 1-2 级患者从 152 分钟（IQR 102-249）降至 135 分钟（IQR 91-227；P < 0.001）。所有患者的院内死亡率从 1.7%降至 0.9%[调整后的 OR 0.36（95%CI 0.22-0.59），P < 0.001]。计划转入 ICU 的患者人数从 113 例（2.8%）降至 91 例（2.1%）[调整后的 OR 0.73（95%CI 0.53-0.99），P = 0.04]。