Department of Gynecology and Obstetrics, Universidade Federal de São Paulo, Escola Paulista de Medicina (Unifesp-EPM), Brazil.
Taiwan J Obstet Gynecol. 2019 May;58(3):359-363. doi: 10.1016/j.tjog.2019.02.010.
To compare clinical and surgical outcomes in patients admitted to a gynecological surgery ward before and after the implementation of an evidence-based multimodal and multiprofessional care protocol by the hospital staff.
In this historically-controlled cross-sectional study, we compared clinical and surgical outcomes among all women admitted to the gynecological ward of a university public hospital for elective surgery for various reasons before and after the implementation of a multimodal care protocol. The protocol had been implemented to adjust the following procedures to evidence-based recommendations: fluid management/hydration, antimicrobial prophylaxis, management of nausea and vomiting, antithrombotic prophylactic therapy, preoperative fasting, mechanical bowel preparation (reduction), pain management, use of urinary catheters, and stimulus to ambulation.
After the protocol implementation, fasting time was reduced in approximately 10 h. Patients had to undergo bowel preparation significantly less frequently, and the volume of fluids was reduced too. The use of nausea and vomit prophylaxis increased almost 20 times, but only nausea episodes were reduced. The frequency of antithrombotic prophylactic therapy more than doubled. Hospitalization time decreased significantly.
In this study, we observed significant improvements in clinical outcomes after the implementation of a multimodal protocol for perioperative care in the gynecological ward of a public university hospital in Brazil. The protocol implementation was associated with reductions in fasting time, bowel preparation, administration of fluids, pain, nausea and hospitalization time, allowing the treatment of more patients per year in the same ward.
比较医院工作人员实施基于证据的多模式多专业护理方案前后，入住妇科手术病房的患者的临床和手术结果。
在这项历史性对照的横断面研究中，我们比较了在实施多模式护理方案前后，因各种原因入住大学公立医院妇科病房接受择期手术的所有女性的临床和手术结果。该方案的实施旨在根据循证建议调整以下程序：液体管理/补液、抗菌预防、恶心和呕吐管理、抗血栓预防治疗、术前禁食、机械肠道准备（减少）、疼痛管理、使用导尿管和刺激活动。
实施方案后，禁食时间缩短了约 10 小时。患者需要进行肠道准备的频率显著降低，液体量也减少了。恶心和呕吐预防的使用增加了近 20 倍，但仅减少了恶心发作的次数。抗血栓预防治疗的频率增加了一倍多。住院时间明显缩短。
在这项研究中，我们观察到在巴西一所公立大学医院的妇科病房实施围手术期多模式护理方案后，临床结果有了显著改善。方案的实施与禁食时间、肠道准备、液体管理、疼痛、恶心和住院时间的减少有关，允许在同一病房每年治疗更多的患者。
