一种新型神经科学中级护理单元模式：对患者流程和安全影响的回顾性分析
A Novel Neuroscience Intermediate-Level Care Unit Model: Retrospective Analysis of Impact on Patient Flow and Safety.
作者信息
Quimby Alexandra E, Shamy Michel C F, Rothwell Deanna M, Liu Erin Y, Dowlatshahi Dar, Stotts Grant
机构信息
Department of Otolaryngology-Head & Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
出版信息
Neurohospitalist. 2017 Apr;7(2):83-90. doi: 10.1177/1941874416672558. Epub 2016 Oct 15.
BACKGROUND AND PURPOSE
Neurointensive care units have been shown to improve patient outcomes across a variety of neurological and neurosurgical conditions. However, the efficacy of less resource-intensive intermediate-level care units to deliver similar care has not been well studied. The purpose of this study is to evaluate the impact of neurocritical specialist comanagement on patient flow and safety in a neuroscience intermediate-level care unit.
METHODS
Our intervention consisted of the addition of a physician with critical care experience as well as training in neurology, anesthesiology, or intensive care to a neuroscience intermediate-level care unit to comanage patients alongside neurology and neurosurgery staff during weekday daytime hours. A retrospective analysis was performed on prospectively collected data pertaining to all patients admitted to the unit over a 3-year period, 1 year before our intervention and 2 years after. Patient statistics including wait times to admission, length of stay (LOS), and mortality were reviewed.
RESULTS
Following the intervention, there were significant reductions in wait times to unit admission from both the emergency department and postanesthetic care unit, as well as reductions in the average LOS. No significant safety concerns were identified.
CONCLUSION
This study has demonstrated that the optimization of a neuroscience intermediate-level care unit involving comanagement of patients by a neurocritical specialist can reduce wait times to admission and lengths of stay, with preserved safety outcomes.
背景与目的
神经重症监护病房已被证明能改善各种神经科和神经外科疾病患者的预后。然而，资源消耗较少的中级护理病房提供类似护理的效果尚未得到充分研究。本研究的目的是评估神经重症专科共同管理对神经科学中级护理病房患者流程和安全性的影响。
方法
我们的干预措施包括增加一名具有重症监护经验以及接受过神经病学、麻醉学或重症监护培训的医生，在工作日白天与神经科和神经外科工作人员一起对神经科学中级护理病房的患者进行共同管理。对前瞻性收集的与该病房在干预前1年和干预后2年期间收治的所有患者相关的数据进行回顾性分析。审查了患者统计数据，包括入院等待时间、住院时间（LOS）和死亡率。
结果
干预后，急诊室和麻醉后护理病房的入院等待时间均显著缩短，平均住院时间也有所缩短。未发现重大安全问题。
结论
本研究表明，通过神经重症专科医生对患者进行共同管理来优化神经科学中级护理病房，可以减少入院等待时间和住院时间，同时保持安全结果。
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