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患者可见性与重症监护病房死亡率:一项概念性重复研究

Patient visibility and ICU mortality: a conceptual replication.

作者信息

Lu Yi, Ossmann Michelle M, Leaf David E, Factor Philip H

机构信息

CORRESPONDING AUTHOR: Yi Lu, PhD, Division of Building Science and Technology, City University of Hong Kong;

出版信息

HERD. 2014 Winter;7(2):92-103. doi: 10.1177/193758671400700206.

Abstract

OBJECTIVE

This study reanalyzes the data from a study by Leaf, Homel, and Factor (2010) titled "Relationship between ICU Design and Mortality" by adopting and developing objective visibility measures.

BACKGROUND

Various studies attribute healthcare outcomes (patient falls, satisfaction) to a vague notion of patient room visibility. The study by Leaf and colleagues was the first to draw an independent association between patient mortality and patient room visibility, however "visibility" remains imprecise.

METHODS

The original patient dataset was obtained from Dr. Leaf. The 664 patient sample assigned across 12 rooms at the medical ICU at Columbia University Medical Center was reanalyzed in terms of targeted visibility; the unit of analysis was the room, n = 12. Several computer-based visibility measures of patient rooms were used: patient head visibility, patient room visibility, and field of view to nursing station. Patient head visibility was defined as the percentage of area within the central nursing station from which the patient head could be seen; patient room visibility was defined as the percentage of area within the central nursing station that could see the patient room (average value of all patient room grids); field of view was defined as the maximum viewing angle from the patient head to the central nursing station.

RESULTS

Among the sickest patients (those with Acute Physiology and Chronic Health Evaluation II > 30), field of view accounted for 33.5% of the variance in ICU mortality, p = 0.049.

CONCLUSIONS

Subtle differences in patient room visibility may have important effects on clinical outcomes.

KEYWORDS

Case study, critical care/intensive care, methodology, outcomes.

摘要

目的

本研究通过采用并开发客观的可见性测量方法,重新分析了Leaf、Homel和Factor(2010年)发表的题为《重症监护病房设计与死亡率之间的关系》的研究数据。

背景

多项研究将医疗保健结果(患者跌倒、满意度)归因于患者病房可见性这一模糊概念。Leaf及其同事的研究首次得出患者死亡率与患者病房可见性之间的独立关联,然而“可见性”仍然不够精确。

方法

原始患者数据集来自Leaf博士。对哥伦比亚大学医学中心内科重症监护病房12个房间分配的664名患者样本,就目标可见性进行了重新分析;分析单位是房间,n = 12。使用了几种基于计算机的患者病房可见性测量方法:患者头部可见性、患者病房可见性以及到护理站的视野。患者头部可见性定义为中央护理站内能够看到患者头部的区域百分比;患者病房可见性定义为中央护理站内能够看到患者病房的区域百分比(所有患者病房网格的平均值);视野定义为从患者头部到中央护理站的最大视角。

结果

在病情最严重的患者(急性生理与慢性健康状况评价II>30)中,视野占重症监护病房死亡率方差的33.5%,p = 0.049。

结论

患者病房可见性的细微差异可能对临床结果产生重要影响。

关键词

案例研究、重症监护、方法学、结果。

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