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外科重症监护病房跨学科查房对跨专业协作及护理质量的影响:定性与定量混合研究

Impact of surgical intensive care unit interdisciplinary rounds on interprofessional collaboration and quality of care: Mixed qualitative-quantitative study.

作者信息

Urisman Tatiana, Garcia Alberto, Harris Hobart W

机构信息

Department of Nursing, University of California San Francisco, San Francisco, CA, USA.

Department of Nursing, University of California San Francisco, San Francisco, CA, USA.

出版信息

Intensive Crit Care Nurs. 2018 Feb;44:18-23. doi: 10.1016/j.iccn.2017.07.001. Epub 2017 Aug 31.

Abstract

BACKGROUND

Interprofessional collaboration is a key requirement for safe and effective care delivery in the critical care setting. To promote collaboration between care providers, intensive care unit interdisciplinary rounds have been introduced by multiple institutions and subsequent subjective improvements in interprofessional collaboration have been reported. However, only limited data are currently available regarding the impact of these rounds on objective patient care outcomes.

OBJECTIVES

The study had two main goals: (i) to evaluate the impact of introducing an interdisciplinary rounding format that formalised the participation of nurses in rounds on the effectiveness of interprofessional collaboration, specifically between nurses and physicians; and (ii) to evaluate a possible impact of adopting these rounds on measurable patient care outcomes.

METHODS

General surgery rounds were introduced in our 32-bed medical-surgical intensive care unit. The impact of the rounds on the quality of collaboration was measured using anonymous web-based surveys of nurses and surgeons. Rates of falls and self-extubations (adverse events) were compared during five month pre- and post-intervention periods (August 2014-Jun 2015).

RESULTS

Both nurses and physicians reported subjective improvement in collaboration following the introduction of interdisciplinary rounds. Additionally, a decline in both rates of falls and self-extubations was observed in the post-intervention period; however, due to the rarity of these events, neither trend reached statistical significance.

CONCLUSIONS

Interdisciplinary rounds provide an attractive model for improving interprofessional collaboration in critical care. Our findings add support to the growing evidence that interdisciplinary rounds improve collaboration and have a positive impact on the quality of patient care delivery.

摘要

背景

跨专业协作是重症监护环境中安全有效提供护理的关键要求。为促进护理提供者之间的协作,多个机构引入了重症监护病房跨学科查房,随后有报告称跨专业协作在主观上有所改善。然而,目前关于这些查房对客观患者护理结果影响的数据有限。

目的

该研究有两个主要目标:(i)评估引入一种使护士正式参与查房的跨学科查房形式对跨专业协作有效性的影响,特别是护士与医生之间的协作;(ii)评估采用这些查房对可衡量的患者护理结果可能产生的影响。

方法

在我们拥有32张床位的内科 - 外科重症监护病房引入普通外科查房。通过对护士和外科医生进行基于网络的匿名调查来衡量查房对协作质量的影响。在干预前和干预后的五个月期间(2014年8月 - 2015年6月)比较跌倒和自行拔管(不良事件)的发生率。

结果

护士和医生均报告称引入跨学科查房后协作在主观上有所改善。此外,在干预后观察到跌倒和自行拔管的发生率均有所下降;然而,由于这些事件很少发生,两种趋势均未达到统计学意义。

结论

跨学科查房为改善重症监护中的跨专业协作提供了一个有吸引力的模式。我们的研究结果为越来越多的证据提供了支持,即跨学科查房可改善协作并对患者护理质量产生积极影响。

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