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把握时间:实施基于预约的以家庭为中心的查房

Keeping Time: Implementing Appointment-based Family-centered Rounds.

作者信息

Bekmezian Arpi, Fiore Darren M, Long Michele, Monash Bradley J, Padrez Ryan, Rosenbluth Glenn, Sun Karen I

机构信息

Division of Pediatric Hospital Medicine, UCSF Benioff Children's Hospital, San Francisco, CA.

Division of Hospital Medicine, UCSF, San Francisco, CA.

出版信息

Pediatr Qual Saf. 2019 May 23;4(4):e182. doi: 10.1097/pq9.0000000000000182. eCollection 2019 Jul-Aug.

Abstract

BACKGROUND

Family-centered rounds (FCRs) provide many benefits over traditional rounds, including higher patient satisfaction, and shared mental models among staff. These benefits can only be achieved when key members of the care team are present and engaged. We aimed to improve patient engagement and satisfaction with our existing bedside rounds by designing a new FCR process.

METHODS

We conducted a needs assessment and formed a multidisciplinary FCR committee that identified appointment-based family-centered rounds (aFCRs) as a primary intervention. We designed, implemented, and iteratively refined an aFCR process. We tracked process metrics (rounds attendance by key participants), a balancing metric (time per patient), and outcome metrics (patient satisfaction domains) during the intervention and follow-up periods.

RESULTS

After implementing aFCR, 65% of patients reported positive experience with rounds and communication. Rounds duration per patient was similar (9 versus 9.4 min). Nurse, subspecialist, and interpreter attendance on rounds was 72%, 60%, and 90%, respectively. We employed a Rounding Coordinator to complete the scheduling and communication required for successful aFCR.

DISCUSSION

We successfully improved our rounding processes through the introduction of aFCR with the addition of a rounding coordinator. Our experience demonstrates one method to increase multidisciplinary team member attendance on rounds and patient satisfaction with physician communication in the inpatient setting.

摘要

背景

以家庭为中心的查房(FCRs)相较于传统查房有诸多益处,包括更高的患者满意度以及医护人员之间共享的心智模式。只有当护理团队的关键成员到场并参与其中时,这些益处才能实现。我们旨在通过设计一种新的FCR流程来提高患者参与度以及对我们现有床边查房的满意度。

方法

我们进行了需求评估,并组建了一个多学科FCR委员会,该委员会将基于预约的以家庭为中心的查房(aFCRs)确定为主要干预措施。我们设计、实施并反复完善了一个aFCR流程。在干预期和随访期,我们跟踪了流程指标(关键参与者的查房出勤率)、平衡指标(每位患者的时间)以及结果指标(患者满意度领域)。

结果

实施aFCR后,65%的患者对查房和沟通给予了积极评价。每位患者的查房时长相似(9分钟对9.4分钟)。护士、专科医生和口译员的查房出勤率分别为72%、60%和90%。我们聘请了一名查房协调员来完成成功开展aFCR所需的排班和沟通工作。

讨论

我们通过引入aFCR并增设一名查房协调员,成功改进了我们的查房流程。我们的经验展示了一种在住院环境中提高多学科团队成员查房出勤率以及患者对医生沟通满意度的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fdf9/6708638/7b16c4943ec4/pqs-4-e182-g002.jpg

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