Intensive Care Unit, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Rovira I Virgili University, Tarragona, Spain,
Intensive Care Med. 2015 Jun;41(6):1089-98. doi: 10.1007/s00134-015-3792-3. Epub 2015 Apr 14.
The two aims of this study were first to analyse the feasibility and utility (to improve the care process) of implementing a new real time random safety tool and second to explore the efficacy of this tool in core hospitals (those participating in tool design) versus non-core hospitals.
This was a prospective study conducted over a period of 4 months in six adult intensive care units (two of which were core hospitals). Safety audits were conducted 3 days per week during the entire study period to determine the efficacy of the 37 safety measures (grouped into ten blocks). In each audit, 50% of patients and 50% of measures were randomized. Feasibility was calculated as the proportion of audits completed over those scheduled and time spent, and utility was defined as the changes in the care process resulting from tool application.
A total of 1323 patient-days were analysed. In terms of feasibility, 87.6% of the scheduled audits were completed. The average time spent per audit was 34.5 ± 29 min. Globally, changes in the care process occurred in 5.4% of the measures analysed. In core hospitals, utility was significantly higher in 16 of the 37 measures, all of which were included in good clinical practice guidelines. Most of the clinical changes brought about by the tool occurred in the mechanical ventilation and haemodynamics blocks. Multivariate analyses demonstrated that changes in the care process in each block were associated with the core hospital variable, staffing ratios and severity of patient disease.
Real time safety audits improved the care process and adherence to the clinical practice guidelines and proved to be most useful in situations of high care load and in patients with more severe disease. The effect was greater in core hospitals.
本研究的两个目的是首先分析实施新的实时随机安全工具的可行性和实用性（以改善护理流程），其次是探索该工具在核心医院（参与工具设计的医院）与非核心医院的效果。
这是一项为期 4 个月的前瞻性研究，在 6 个成人重症监护病房（其中 2 个为核心医院）进行。在整个研究期间，每周进行 3 次安全审核，以确定 37 项安全措施（分为 10 个组块）的效果。每次审核中，随机选择 50%的患者和 50%的措施。可行性计算为已完成审核与计划审核之比，以及所用时间。实用性定义为工具应用对护理流程的改变。
共分析了 1323 个患者日。在可行性方面，完成了计划审核的 87.6%。每次审核的平均用时为 34.5±29 分钟。总体而言，分析的措施中有 5.4%的护理流程发生了变化。在核心医院，37 项措施中有 16 项的实用性显著更高，且均包含在良好临床实践指南中。工具带来的大多数临床变化发生在机械通气和血液动力学组块。多变量分析表明，每个组块的护理流程变化与核心医院变量、人员配备比例和患者疾病严重程度有关。
实时安全审核改善了护理流程和对临床实践指南的依从性，并且在高护理负荷和病情更严重的患者中最有用。在核心医院效果更大。
