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一种新的学术性重症监护病房设施绩效评估的研究方案:对患者护理的影响。

A study protocol for performance evaluation of a new academic intensive care unit facility: impact on patient care.

机构信息

Department of Critical Care Medicine, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada.

出版信息

BMJ Open. 2013 Jul 19;3(7). doi: 10.1136/bmjopen-2013-003134. Print 2013.

Abstract

BACKGROUND

Healthcare facility construction is increasing because of population demand and the need to replace ageing infrastructure. Research suggests that there may be a relationship between healthcare environment and patient care. To date, most evaluations of new healthcare facilities are derived from techniques used in other industries and focus on physical, financial and architectural performance. However, few studies have evaluated the impact of healthcare facility design on processes and outcomes of patient care.

STUDY AIMS

The primary objective of this study was to investigate the impact of relocation to a new intensive care unit (ICU) facility on clinical performance measures. This study also proposes to develop and test a framework for facility performance evaluation using accepted ICU design guidelines and Donabedian's model for healthcare quality.

METHODS AND ANALYSIS

We will utilise a mixed-methods, observational, retrospective, controlled, before-and-after design to take advantage of the quasiexperimental conditions created with the construction of a new ICU facility in Calgary, Canada. For the qualitative substudy, we will conduct individual interviews with end-users to understand their impressions and experiences with the new environment and perform thematic analysis. For the quantitative substudy, we will compare process of care indicators and patient outcomes for the 12-month period before and after relocation to the new facility. Two other local ICU facilities that did not undergo structural change during the study period will serve as controls. We will triangulate qualitative and quantitative results utilising a novel framework.

ETHICS AND DISSEMINATION

The results of this study will contribute in understanding the impact of new ICU facilities on clinical performance measures centred on patients, their families and healthcare providers. The framework will complement existing building performance evaluation techniques and help healthcare administrators plan new ICU facilities. The University of Calgary Research Ethics Board approved this study protocol.

摘要

背景

由于人口需求和替换老化基础设施的需要,医疗机构的建设正在增加。研究表明,医疗环境与患者护理之间可能存在关系。迄今为止,对新医疗设施的大多数评估都源自其他行业使用的技术,并且侧重于物理、财务和建筑性能。然而,很少有研究评估医疗设施设计对患者护理过程和结果的影响。

研究目的

本研究的主要目的是调查迁至新重症监护病房(ICU)设施对临床绩效评估指标的影响。本研究还提议开发和测试一种使用公认的 ICU 设计指南和 Donabedian 医疗保健质量模型的设施绩效评估框架。

方法和分析

我们将采用混合方法、观察性、回顾性、对照、前后设计,利用在加拿大卡尔加里建造新 ICU 设施所创造的准实验条件。对于定性子研究,我们将对最终用户进行个人访谈,以了解他们对新环境的印象和体验,并进行主题分析。对于定量子研究,我们将比较搬迁到新设施前后 12 个月的护理过程指标和患者结局。在研究期间没有进行结构变化的另外两个当地 ICU 设施将作为对照。我们将利用一种新颖的框架对定性和定量结果进行三角剖分。

伦理和传播

这项研究的结果将有助于理解新 ICU 设施对以患者、他们的家人和医疗保健提供者为中心的临床绩效评估指标的影响。该框架将补充现有的建筑性能评估技术,并帮助医疗保健管理人员规划新的 ICU 设施。卡尔加里大学研究伦理委员会批准了本研究方案。

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本文引用的文献

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Guidelines for intensive care unit design.重症监护病房设计指南。
Crit Care Med. 2012 May;40(5):1586-600. doi: 10.1097/CCM.0b013e3182413bb2.
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The role of the physical environment in crossing the quality chasm.物理环境在跨越质量鸿沟中的作用。
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