Miller Anne, Wagner Chad E, Song Yanna, Burns Kathleen, Ahmad Rashid, Lee Parmley C, Weinger Matthew B
Departments of Anesthesiology and Critical Care.
Departments of Anesthesiology and Critical Care.
J Cardiothorac Vasc Anesth. 2014 Jun;28(3):441-7. doi: 10.1053/j.jvca.2014.01.010. Epub 2014 Apr 16.
To test the effect of a high reliability organization (HRO) intervention on patient lengths of stay in the CVICU and hospital. The authors proposed that (1) higher safety related evidence based protocol (SREBP) team compliance scores and (2) lower SREBP milestone scores are associated with shorter lengths of CVICU and hospital stay.
A prospective, longitudinal observational evaluation was used to assess the effects of SREBP-focused rounding processes and a milestone-tracking tool.
United States, university academic medical center's 27-bed CVICU.
Six hundred sixty-five adult cardiac surgery patients and the CVICU care team (100 registered nurses and 16 clinical providers) participated.
Team compliance was the proportion of SREBP-related team behaviors exhibited during daily rounds. Patients' milestone scores were the cumulative difference between actual and expected times for 4 SREBP milestones over 48 hours. Milestones achieved earlier than expected indicated reduced complication risk, and milestones achieved later than expected indicated increased risk. As team compliance increased, CVICU length of stay decreased 0.66 (95% CI: -0.04 to 1.28; p = 0.08) days; hospital stay decreased 0.89 times (95% CI: 0.77-1.03; p = 0.008). As the mean milestone scores increased from -7 to 12, length of ICU stay increased 2.63 (95% CI: 1.66-3.59; p<0.001) days; hospital length of stay increased 1.44 times (95% CI: 1.23-1.7; p = 0.05).
A milestone-driven pathway supported by team rounding was associated with decreased lengths of CVICU and hospital stay. However, tracking patient trajectories by milestones suggests a more complex relationship than anticipated and presents new opportunities for SREBP implementation and research.
测试高可靠性组织（HRO）干预对心血管重症监护病房（CVICU）患者住院时间及医院住院时间的影响。作者提出：（1）更高的基于安全证据的协议（SREBP）团队依从性得分，以及（2）更低的SREBP里程碑得分与CVICU住院时间及医院住院时间缩短相关。
采用前瞻性纵向观察性评估，以评估聚焦SREBP的查房流程和里程碑追踪工具的效果。
美国，大学学术医疗中心拥有27张床位的CVICU。
665名成年心脏手术患者及CVICU护理团队（100名注册护士和16名临床医疗人员）参与其中。
团队依从性是指日常查房期间表现出的与SREBP相关的团队行为比例。患者的里程碑得分是48小时内4个SREBP里程碑实际时间与预期时间的累积差值。早于预期达成的里程碑表明并发症风险降低，晚于预期达成的里程碑表明风险增加。随着团队依从性的提高，CVICU住院时间减少0.66天（95%置信区间：-0.04至1.28；p = 0.08）；医院住院时间减少0.89倍（95%置信区间：0.77 - 1.03；p = 0.008）。随着平均里程碑得分从-7增加到12，ICU住院时间增加2.63天（95%置信区间：1.66 - 3.59；p<0.001）；医院住院时间增加1.44倍（95%置信区间：1.23 - 1.7；p = 0.05）。
由团队查房支持的里程碑驱动路径与CVICU住院时间及医院住院时间缩短相关。然而，通过里程碑追踪患者轨迹表明其关系比预期更为复杂，并为SREBP的实施和研究带来了新机遇。
