Clay-Williams Robyn, Blakely Brette, Lane Paul, Senthuran Siva, Johnson Andrew
Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Townsville Hospital and Health Service, Townsville, Queensland, Australia.
BMJ Open. 2019 Mar 9;9(3):e025041. doi: 10.1136/bmjopen-2018-025041.
To evaluate the implementation of an intensive care unit (ICU) intervention designed to establish rules for making ICU decisions about postsurgery beds.
Preintervention/postintervention case study using a multimethod approach, involving two phases of staff interviews, process mapping and collection of administrative data.
ICU in a 700-bed regional tertiary care hospital in Australia.
31 interview participants. Phases 1 and 2 participants drawn from three groups of staff: bedside nursing staff in the ICU, ICU specialist doctors and senior management staff involved in oversight of ICU operations. Phase 2 included an additional participant group: staff from surgery and emergency departments.
Implementation of an ICU escalation plan and introduction of a multidisciplinary morning meeting to determine ICU bed status in accordance with the plan.
Interview data consisted of preintervention staff perceptions of ICU workplace cohesiveness with bed pressure, and postintervention staff perceptions of the escalation plan and ICU performance. Administrative data consisted of bed status (red, amber or green), monthly number of planned elective surgeries requiring an ICU bed and monthly number of elective surgeries cancelled due to unavailability of ICU beds.
Improved internal communication, decision making and cohesion within the ICU and better coordination between ICU and other hospital departments. Significant reduction in elective surgeries cancelled due to unavailability of ICU beds, χ=24.9, p<0.0001.
By establishing rules for decision making around ICU bed allocation, the intervention improved internal professional relationships within the ICU as well as between the ICU and external departments and reduced the number of elective surgeries cancelled.
评估一项重症监护病房（ICU）干预措施的实施情况，该措施旨在制定关于ICU术后床位决策的规则。
采用多方法的干预前/干预后案例研究，包括两个阶段的员工访谈、流程映射和行政数据收集。
澳大利亚一家拥有700张床位的地区三级医院的ICU。
31名访谈参与者。第1阶段和第2阶段的参与者来自三组员工：ICU床边护理人员、ICU专科医生以及参与ICU运营监督的高级管理人员。第2阶段还包括一个额外的参与者群体：外科和急诊科的员工。
实施ICU升级计划，并引入多学科晨会，以根据该计划确定ICU床位状态。
访谈数据包括干预前员工对ICU工作场所凝聚力与床位压力的看法，以及干预后员工对升级计划和ICU绩效的看法。行政数据包括床位状态（红色、琥珀色或绿色）、每月需要ICU床位的计划择期手术数量以及因ICU床位不可用而取消的择期手术数量。
ICU内部沟通、决策和凝聚力得到改善，ICU与其他医院科室之间的协调也更好。因ICU床位不可用而取消的择期手术显著减少，χ=24.9，p<0.0001。
通过制定ICU床位分配的决策规则，该干预措施改善了ICU内部以及ICU与外部科室之间的专业关系，并减少了择期手术取消的数量。
