提高英国的气管造口术护理质量：20 家不同医院参与的指导式质量改进计划的结果。
Improving tracheostomy care in the United Kingdom: results of a guided quality improvement programme in 20 diverse hospitals.
机构信息
Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; Manchester University NHS Foundation Trust, Manchester, UK.
Manchester University NHS Foundation Trust, Manchester, UK.
出版信息
Br J Anaesth. 2020 Jul;125(1):e119-e129. doi: 10.1016/j.bja.2020.04.064. Epub 2020 May 31.
BACKGROUND
Inconsistent and poorly coordinated systems of tracheostomy care commonly result in frustrations, delays, and harm. Quality improvement strategies described by exemplar hospitals of the Global Tracheostomy Collaborative have potential to mitigate such problems. This 3 yr guided implementation programme investigated interventions designed to improve the quality and safety of tracheostomy care.
METHODS
The programme management team guided the implementation of 18 interventions over three phases (baseline/implementation/evaluation). Mixed-methods interviews, focus groups, and Hospital Anxiety and Depression Scale questionnaires defined outcome measures, with patient-level databases tracking and benchmarking process metrics. Appreciative inquiry, interviews, and Normalisation Measure Development questionnaires explored change barriers and enablers.
RESULTS
All sites implemented at least 16/18 interventions, with the magnitude of some improvements linked to staff engagement (1536 questionnaires from 1019 staff), and 2405 admissions (1868 ICU/high-dependency unit; 7.3% children) were prospectively captured. Median stay was 50 hospital days, 23 ICU days, and 28 tracheostomy days. Incident severity score reduced significantly (n=606; P<0.01). There were significant reductions in ICU (-;0.25 days month), ventilator (-;0.11 days month), tracheostomy (-;0.35 days month), and hospital (-;0.78 days month) days (all P<0.01). Time to first vocalisation and first oral intake both decreased by 7 days (n=733; P<0.01). Anxiety decreased by 44% (from 35.9% to 20.0%), and depression decreased by 55% (from 38.7% to 18.3%) (n=385; both P<0.01). Independent economic analysis demonstrated £33 251 savings per patient, with projected annual UK National Health Service savings of £275 million.
CONCLUSIONS
This guided improvement programme for tracheostomy patients significantly improved the quality and safety of care, contributing rich qualitative improvement data. Patient-centred outcomes were improved along with significant efficiency and cost savings across diverse UK hospitals.
CLINICAL TRIAL REGISTRATION
IRAS-ID-206955; REC-Ref-16/LO/1196; NIHR Portfolio CPMS ID 31544.
背景
气管切开术护理的系统不一致且协调不良，通常会导致挫折、延误和伤害。全球气管切开术协作组织的模范医院所描述的质量改进策略有可能减轻此类问题。这项为期 3 年的有指导的实施计划研究了旨在提高气管切开术护理质量和安全性的干预措施。
方法
项目管理团队指导实施了三个阶段（基线/实施/评估）的 18 项干预措施。混合方法访谈、焦点小组和医院焦虑和抑郁量表问卷确定了结果衡量标准，患者层面的数据库跟踪和基准测试流程指标。欣赏式询问、访谈和规范措施开发问卷探讨了变革的障碍和促进因素。
结果
所有站点均实施了至少 16/18 项干预措施，一些改进的程度与员工参与度相关（1019 名员工中的 1536 份问卷），前瞻性采集了 2405 例入院患者（1019 名员工中的 1536 份问卷）（1868 例 ICU/高依赖病房；7.3%为儿童）。中位住院时间为 50 天，ICU 为 23 天，气管切开术为 28 天。严重程度评分显著降低（n=606；P<0.01）。ICU（-0.25 天/月）、呼吸机（-0.11 天/月）、气管切开术（-0.35 天/月）和医院（-0.78 天/月）天数均显著减少（均 P<0.01）。首次发声和首次口服摄入的时间均减少了 7 天（n=733；P<0.01）。焦虑降低了 44%（从 35.9%降至 20.0%），抑郁降低了 55%（从 38.7%降至 18.3%）（n=385；均 P<0.01）。独立的经济分析表明，每位患者可节省 33251 英镑，英国国民健康保险制度的年度节省额预计为 2.75 亿英镑。
结论
这项针对气管切开术患者的有指导的改进计划显著提高了护理质量和安全性，提供了丰富的定性改进数据。患者为中心的结果得到了改善，同时在英国多家医院实现了显著的效率和成本节约。
临床试验注册
IRAS-ID-206955；REC-Ref-16/LO/1196；NIHR 组合 CPMS ID 31544。
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