Kliger Julie, Singer Sara J, Hoffman Frank H
The Altos Group, Oakland, CA, USA.
Jt Comm J Qual Patient Saf. 2015 Jun;41(6):264-72. doi: 10.1016/s1553-7250(15)41036-0.
The Integrated Nurse Leadership Program (INLP) is a collaborative improvement model focused on developing practical leadership skills of nurses and other frontline clinicians to lead quality improvement efforts. Sepsis is a major challenge to treat because it arises unpredictably and can progress rapidly. Nine San Francisco Bay Area hospitals participated in a 22-month INLP Sepsis Mortality Reduction Project to improve sepsis detection and management.
The INLP focused on developing leadership and process improvement skills of nurses and other frontline clinicians. Teams of trained clinicians then implemented three strategies to improve early identification and timely treatment of sepsis: (1) sepsis screening of all patients, with diagnostic testing according to protocol; (2) timely treatment on the basis of key elements of Early Goal-Directed Therapy (EGDT); and (3) ongoing data review. Each hospital agreed to pursue the goal of reducing sepsis mortality by 15% by the end of the project.
In the data collection period (baseline, July-December 2008 and project completion, January-June 2011), team members showed strong improvement in perceived leadership skills, team effectiveness, and ability to improve care quality. During this period, sepsis mortality for eight of the participating hospitals (Hospital 9 joined the project six months after it began) decreased by 43.7%-from 28% in the baseline period to 16% at project completion. Sepsis mortality rates trended downward for all hospitals, significantly decreasing (p<.05 at one hospital, p<.01 for four hospitals).
In addition to improvement in safety culture and management of septic patients, hospitals participating in the INLP Sepsis Mortality Reduction Project achieved reductions in sepsis mortality during the study period and sustained reductions for more than one year later. The INLP model can be readily applied beyond sepsis management and mortality to other quality problems.
综合护士领导力项目（INLP）是一种合作改进模式，专注于培养护士及其他一线临床医生的实践领导技能，以引领质量改进工作。脓毒症是治疗中的一项重大挑战，因为其发病不可预测且进展迅速。旧金山湾区的九家医院参与了一项为期22个月的INLP脓毒症死亡率降低项目，以改善脓毒症的检测与管理。
INLP致力于培养护士及其他一线临床医生的领导能力和流程改进技能。经过培训的临床医生团队随后实施了三项策略，以改善脓毒症的早期识别和及时治疗：（1）对所有患者进行脓毒症筛查，并根据方案进行诊断检测；（2）基于早期目标导向治疗（EGDT）的关键要素及时进行治疗；（3）持续进行数据审查。每家医院都同意在项目结束时实现将脓毒症死亡率降低15%的目标。
在数据收集期（基线期，2008年7月至12月；项目完成期，2011年1月至6月），团队成员在感知到的领导技能、团队效能以及改善护理质量的能力方面有显著提升。在此期间，八家参与项目的医院（医院9在项目开始六个月后加入）的脓毒症死亡率下降了43.7%，从基线期的28%降至项目完成时的16%。所有医院的脓毒症死亡率均呈下降趋势，其中一家医院显著下降（p<0.05），四家医院极显著下降（p<0.01）。
除了安全文化和脓毒症患者管理方面有所改善外，参与INLP脓毒症死亡率降低项目的医院在研究期间实现了脓毒症死亡率的降低，并在一年多后持续保持降低水平。INLP模式可轻松应用于脓毒症管理和死亡率之外的其他质量问题。
