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预防方案对危重症患者转运过程中事件发生的影响。

Impact of a preventive programme on the occurrence of incidents during the transport of critically ill patients.

机构信息

Intensive Care Unit, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.

出版信息

Intensive Crit Care Nurs. 2013 Feb;29(1):9-19. doi: 10.1016/j.iccn.2012.07.001. Epub 2012 Aug 24.

Abstract

OBJECTIVE

Incidents related to transport of critically ill patients have been extensively reported. The objective of this study was to determine the effect of an interdisciplinary preventive programme used by all intensive care unit team members involved in patients' transport on the rate of these incidents.

METHODS

A clinical quality improvement audit using a prospective pre and post intervention design was performed among medical and surgical patients hospitalised in intensive care who required intra or inter-hospital transport.

RESULTS

A total of 180 transports occurred in the pre-implementation phase of the study and 187 transports in the post-implementation phase. A 20% absolute reduction of incidents was observed (57.2% vs. 37.4%, p<0.001). Statistically significant reductions were obtained for the technical problems category of incidents (25% vs. 7.5%, p<0.001) as well as the problems related to patient's mobilisation category (14.4% vs. 7.5%, p=0.05). Clinically significant trends were also observed for the clinical deterioration (24.4% vs. 17.1%, p=0.11) and undesired delay before test (23.9% vs. 17.6%, p=0.14) categories but did not reach statistical significance.

CONCLUSIONS

A preventive programme applied by all care providers involved in transport of critically ill patients was associated with a reduction of incidents. The application of such a programme should be acknowledged as a standard of care considering the risks inherent to the transportation of ICU patients.

摘要

目的

与危重症患者转运相关的事件已被广泛报道。本研究的目的是确定所有参与患者转运的重症监护病房团队成员使用的跨学科预防计划对这些事件发生率的影响。

方法

采用前瞻性前后干预设计,对需要院内或院间转运的入住重症监护病房的内科和外科患者进行临床质量改进审核。

结果

在研究的实施前阶段共进行了 180 次转运,在实施后阶段进行了 187 次转运。观察到事件发生率绝对降低了 20%(57.2%比 37.4%,p<0.001)。事件的技术问题类别(25%比 7.5%,p<0.001)和与患者移动相关的问题类别(14.4%比 7.5%,p=0.05)均有统计学显著降低。临床恶化(24.4%比 17.1%,p=0.11)和测试前不期望的延迟(23.9%比 17.6%,p=0.14)这两个类别也观察到了有临床意义的趋势,但未达到统计学意义。

结论

应用于所有参与危重症患者转运的医护人员的预防计划与事件发生率的降低相关。考虑到 ICU 患者转运所固有的风险,应将此类计划的应用视为护理标准。

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