Wagner Brian, Meirowitz Natalie, Shah Jalpa, Nanda Deepak, Reggio Lori, Cohen Phyllis, Britt Karen, Kaufman Leah, Walia Rajni, Bacote Corinne, Lesser Martin L, Pekmezaris Renee, Fleischer Adiel, Abrams Kenneth J
North Shore-Long Island Jewish Health System, Great Neck, NY, USA.
J Healthc Qual. 2012 Jan-Feb;34(1):6-15. doi: 10.1111/j.1945-1474.2011.00134.x. Epub 2011 Mar 1.
A comprehensive perinatal safety initiative (PSI) was incrementally introduced from August 2007 to July 2009 at a large tertiary medical center to reduce adverse obstetrical outcomes. The PSI introduced: (1) evidence-based protocols, (2) formalized team training with emphasis on communication, (3) standardization of electronic fetal monitoring with required documentation of competence, (4) a high-risk obstetrical emergency simulation program, and (5) dissemination of an integrated educational program among all healthcare providers. Eleven adverse outcome measures were followed prospectively via modification of the Adverse Outcome Index (MAOI). Additionally, individual components were evaluated. The logistic regression model found that within the first year, the MAOI decreased significantly to 0.8% from 2% (p<.0004) and was maintained throughout the 2-year period. Significant decreases over time for rates of return to the operating room (p<.018) and birth trauma (p<.0022) were also found. Finally, significant improvements were found in staff perceptions of safety (p<.0001), in patient perceptions of whether staff worked together (p<.028), in the management (p<.002), and documentation (p<.0001) of abnormal fetal heart rate tracings, and the documentation of obstetric hemorrhage (p<.019). This study demonstrates that a comprehensive PSI can significantly reduce adverse obstetric outcomes, thereby improving patient safety and enhancing staff and patient experiences.
2007年8月至2009年7月，一家大型三级医疗中心逐步推行了一项全面的围产期安全倡议（PSI），以减少不良产科结局。该PSI引入了：（1）循证方案；（2）注重沟通的正规团队培训；（3）电子胎儿监护标准化及能力要求文件记录；（4）高危产科紧急模拟项目；（5）在所有医疗服务提供者中传播综合教育项目。通过修改不良结局指数（MAOI），前瞻性地跟踪了11项不良结局指标。此外，还对各个组成部分进行了评估。逻辑回归模型发现，在第一年，MAOI从2%显著降至0.8%（p<0.0004），并在整个2年期间保持这一水平。还发现随着时间推移，手术室返回率（p<0.018）和出生创伤（p<0.0022）显著下降。最后，在工作人员对安全的认知（p<0.0001）、患者对工作人员是否协作（p<0.028）、胎儿心率异常描记图的管理（p<0.002）和记录（p<0.0001）以及产科出血的记录（p<0.019）方面均有显著改善。这项研究表明，全面的PSI可以显著减少不良产科结局，从而提高患者安全并提升工作人员和患者的体验。
