Castaldi Maria, George Geena, Turner Pamela, McNelis John
Jacobi Medical Center, Bronx, NY, USA.
Westchester Medical Center, Valhalla, NY, USA.
J Patient Exp. 2020 Feb;7(1):89-95. doi: 10.1177/2374373518817081. Epub 2018 Dec 9.
National Quality Improvement Project (NSQIP) semiannual reports (SARs) revealed high observed to expected ratios for venous thromboembolic events (VTEs) on the surgical service. Press Ganey scores identified an area of particular weakness in shared decision-making in patient care. Patients reported little to no participation in shared decision-making. A performance improvement project was developed with a 2-fold objective: decrease the percentages of patients sustaining VTE through adequate screening and prophylaxis (VTEP) and to engage patients in shared decision-making to accept VTEP through enhanced patient-centered discussions and education on the risks and benefits of VTEP. A clinical pathway was developed to implement VTEP using a standardized risk assessment tool. Patient-centered discussion introduced VTEP and impact on perioperative safety. Results included telephone survey, NSQIP SARs, and Press Ganey patient experience survey. Using NSQIP data and a pathway developed for both VTE risk assessment and patient engagement, the authors observe immediate improvements in patient experience and decreased rates of VTE.
国家质量改进项目（NSQIP）半年报显示，外科手术服务中静脉血栓栓塞事件（VTE）的观察值与预期值比率较高。Press Ganey评分确定了患者护理中共同决策这一特别薄弱的领域。患者报告称几乎没有参与共同决策。开展了一项绩效改进项目，目标有两个：通过充分筛查和预防措施（VTEP）降低发生VTE的患者百分比，并通过加强以患者为中心的讨论以及关于VTEP风险和益处的教育，让患者参与共同决策以接受VTEP。制定了一条临床路径，使用标准化风险评估工具实施VTEP。以患者为中心的讨论介绍了VTEP及其对围手术期安全的影响。结果包括电话调查、NSQIP半年报和Press Ganey患者体验调查。作者利用NSQIP数据以及为VTE风险评估和患者参与度制定的路径，观察到患者体验立即得到改善，VTE发生率降低。
