改进医护人员的角色定义以减少过度拥挤并改善院内心脏骤停应对情况。

Improving Providers' Role Definitions to Decrease Overcrowding and Improve In-Hospital Cardiac Arrest Response.

作者信息

Leary Marion, Schweickert William, Neefe Stacie, Tsypenyuk Boris, Falk Scott Austin, Holena Daniel N

机构信息

Marion Leary is the Director of Innovation Research, Center for Resuscitation Science, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. William Schweickert is an assistant professor, Division of Allergy and Pulmonary Critical Care, Perelman School of Medicine at the University of Pennsylvania. Stacie Neefe is a nurse clinical coordinator, Department of Nursing, Hospital of the University of Pennsylvania. Boris Tsypenyuk is a project manager, Clinical Effectiveness and Quality Improvement Department, University of Pennsylvania. Scott Austin Falk is an assistant professor, Department of Anesthesia and Critical Care, Perelman School of Medicine at the University of Pennsylvania. Daniel N. Holena is an assistant professor, Division of Traumatology, Surgical Critical Care and Emergency Surgery and a senior scholar, The Leonard Davis Institute, Wharton School of Business, University of Pennsylvania.

出版信息

Am J Crit Care. 2016 Jul;25(4):335-9. doi: 10.4037/ajcc2016195.

DOI:10.4037/ajcc2016195

PMID:27369032

Abstract

BACKGROUND

How nontechnical factors such as inadequate role definition and overcrowding affect outcomes of in-hospital cardiac arrest (IHCA) is unknown. Using a bundled intervention, we sought to improve providers' role definitions and decrease overcrowding during IHCA events.

OBJECTIVES

To determine if a bundled intervention consisting of a nurse/physician leadership dyad, visual cues for provider roles, and a "role check" would lead to reductions in crowding and improve perceptions of communication and team leadership.

METHODS

Baseline data on the number and type of IHCA providers were collected. Providers were asked to complete a postevent survey rating communication and leadership. A bundled intervention was then introduced. Data were then obtained for the subsequent IHCA events.

RESULTS

Twenty ICHA events were captured before and 34 after the intervention. The number of physicians present at pulse checks 2 (median [interquartile range]: 6 [5-8] before vs 5 [3-6] after, P = .02) and 3 (7 [5-9] vs 4 [4-5], P = .004) decreased significantly after the intervention. The overall number of providers at the third pulse check (18 [14-22] before vs 14 [12-16] after, P = .04) also decreased after the intervention. On a 10-point Likert scale, ratings of communication (8 [7-8]) and physician leadership (8 [7-9]) did not differ significantly from before to after the intervention. Both the physician leads (90%) and patients' primary nurses (97%) were able to identify clear nurse leaders.

CONCLUSION

A bundled intervention targeted at improving IHCA response led to a decrease in overcrowding at ICHA events without substantial changes in the perceptions of communication or physician leadership.

摘要

背景

诸如角色定义不明确和过度拥挤等非技术因素如何影响院内心脏骤停（IHCA）的结局尚不清楚。我们采用了一种综合干预措施，旨在改善医护人员的角色定义，并减少IHCA事件期间的过度拥挤情况。

目的

确定由护士/医生领导二元组、医护人员角色视觉提示和“角色检查”组成的综合干预措施是否会减少拥挤，并改善对沟通和团队领导的认知。

方法

收集关于IHCA医护人员数量和类型的基线数据。要求医护人员完成一份事件后调查问卷，对沟通和领导能力进行评分。然后引入综合干预措施。随后获取后续IHCA事件的数据。

结果

干预前记录了20次院内心脏骤停事件，干预后记录了34次。在第2次脉搏检查时在场的医生数量（中位数[四分位间距]：干预前为6[5-8]，干预后为5[3-6]，P = 0.02）和第3次脉搏检查时在场的医生数量（7[5-9]对4[4-5]，P = 0.004）在干预后显著减少。在第3次脉搏检查时医护人员的总数（干预前为18[14-22]，干预后为14[12-16]，P = 0.04）在干预后也有所减少。在10分制的李克特量表上，沟通评分（8[7-8]）和医生领导能力评分（8[7-9]）在干预前后没有显著差异。医生领导（90%）和患者的责任护士（97%）都能够明确识别出护士领导。