用于促进重症监护病房团队沟通和患者早期活动的电子健康记录工具

Electronic Health Record Tool to Promote Team Communication and Early Patient Mobility in the Intensive Care Unit.

作者信息

Anderson Robert J, Sparbel Kathleen, Barr Rhonda N, Doerschug Kevin, Corbridge Susan

机构信息

Robert J. Anderson is an advanced registered nurse practitioner in the intensive care unit, Mayo Clinic, Rochester, Minnesota. Kathleen Sparbel is Director of the College of Nursing, University of Illinois at Chicago, Quad Cities Campus, Moline, Illinois. Rhonda N. Barr is a staff physical therapist specializing in critical care in the medical intensive care unit, University of Iowa Hospitals and Clinics, Iowa City, Iowa. Kevin Doerschug is Medical Director in the medical intensive care unit at University of Iowa Hospitals and Clinics. Susan Corbridge is Associate Dean for Practice and Community Partnerships, College of Nursing, and a nurse practitioner, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.

出版信息

Crit Care Nurse. 2018 Dec;38(6):23-34. doi: 10.4037/ccn2018813.

DOI:10.4037/ccn2018813

PMID:30504495

Abstract

BACKGROUND

Intensive care unit early mobility programs improve patients' outcomes while reducing costs for both patients and institutions. Inadequate interprofessional communication is a known barrier to achieving good early mobility program outcomes. Electronic health record communication tools promoting interprofessional communication have demonstrated improved patient outcomes, but have not been evaluated for mobility in the intensive care unit.

OBJECTIVES

To implement an early mobility collaboration program in an existing early mobility program, consisting of protocol education and an electronic health record tool designed to improve interprofessional communication and collaboration.

METHODS

In phase 1, staff members viewed an online educational module, the existing mobility protocol, and the "Mobility Levels" grading scale. In phase 2, an electronic health record communication tool displayed recently recorded mobility levels to all care providers. Staff knowledge of the early mobility program and perceptions of mobility-related communication were assessed by survey; patient outcomes including mobility goals, mechanical ventilation time, length of intensive care unit stay, and cost were assessed by records review.

RESULTS

Statistically significant increases were found for staff satisfaction with mobility-related communication ( < .001) and communication frequency ( = .02), but not for staff knowledge ( = .28). Hours to achievement of mobility goal ( = .02) and length of intensive care unit stay ( = .02) decreased significantly. Average ventilation time decreased by 27 hours. Discharge recommendations at higher functional levels increased. Total intensive care unit cost decreased significantly (-39.5%; = .04).

CONCLUSIONS

Interprofessional communication and collaboration can lead to improved outcomes. Combining routine educational reviews and an electronic health record communication tool may improve patient and system outcomes for intensive care unit early mobility program patients.

摘要

背景

重症监护病房早期活动计划可改善患者预后，同时降低患者和医疗机构的成本。专业间沟通不足是实现良好早期活动计划结果的已知障碍。促进专业间沟通的电子健康记录沟通工具已证明可改善患者预后，但尚未在重症监护病房的活动方面进行评估。

目的

在现有的早期活动计划中实施一项早期活动协作计划，该计划包括协议教育和旨在改善专业间沟通与协作的电子健康记录工具。

方法

在第1阶段，工作人员观看了在线教育模块、现有的活动协议和“活动水平”分级量表。在第2阶段，一个电子健康记录沟通工具向所有护理人员显示最近记录的活动水平。通过调查评估工作人员对早期活动计划的了解以及对与活动相关沟通的看法；通过记录审查评估患者预后，包括活动目标、机械通气时间、重症监护病房住院时间和成本。

结果

工作人员对与活动相关沟通的满意度（<.001）和沟通频率（=.02）有统计学意义的显著提高，但工作人员知识方面没有（=.28）。实现活动目标的时间（=.02）和重症监护病房住院时间（=.02）显著减少。平均通气时间减少了27小时。更高功能水平的出院建议增加。重症监护病房总成本显著下降（-39.5%；=.04）。