评价标准化术后护理路径在小儿后路脊柱融合患者中的应用效果。
Evaluation of Outcomes Before and After Implementation of a Standardized Postoperative Care Pathway in Pediatric Posterior Spinal Fusion Patients.
机构信息
Kembral L. Nelson, PharmD, Clinical Pharmacist, Nationwide Children's Hospital, Columbus, OH. Lindsey L. Locke, MSN, CPNP-BC, Pediatric Orthopedic Nurse Practitioner, Le Bonheur Children's Hospital, Memphis, TN. Leslie N. Rhodes, DNP, PPCNP-BC, Pediatric Orthopedic Nurse Practitioner, Neuromuscular Clinic; Assistant Professor, University of Tennessee Health Science Center; College of Nursing-Health Promotion and Disease Prevention; LeBonheur Children's Hospital. William A. Mabry, PharmD, MBA, Medication Safety Pharmacist, Assistant Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Clinical Pharmacy and Translational Science, The University of Tennessee Health Science Center, Memphis, TN. Jeffrey R. Sawyer, MD, Orthopedic Surgeon, Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN. William C. Warner, Jr., MD, Orthopedic Surgeon, Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN. Tamekia Jones, PhD, Statistician, Associate Professor, Children's Foundation Research Institute, Memphis, TN; and Department of Pediatrics and Preventive Medicine, The University of Tennessee, Memphis, TN. David D. Spence, MD, Orthopedic Surgeon, Assistant Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN. Derek M. Kelly, MD, Orthopedic Surgeon, Professor, Le Bonheur Children's Hospital, Memphis, TN; and Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN.
出版信息
Orthop Nurs. 2020 Jul/Aug;39(4):257-263. doi: 10.1097/NOR.0000000000000678.
BACKGROUND
Standardized pathways decrease variability and improve outcomes and safety.
PURPOSE
The article aims to evaluate outcomes of a standardized postoperative care pathway compared with individual surgeon preference.
METHODS
A review of patients prestandardization and poststandardization was performed. Patients between the ages of 10-21 years with adolescent idiopathic scoliosis (ICD-9 code 737.30) admitted to the hospital for posterior spinal fusion (CPT code 22630) were included in the study. The prestandardization group (25 patients) was enrolled from April 1, 2010, through March 30, 2011, and the poststandardization group (25 patients) from April 1, 2014, to March 30, 2015. Exclusion criteria were renal disease, epilepsy, neurological disorder, or postoperative complications that led to change in routine care including ileus or fever greater than 102 °F. Data were analyzed using the Wilcoxon signed rank test, with significance set at p < .001.
RESULTS
The length of stay (p = .0166), time to ambulation (p < .0001), patient-controlled analgesia use (p < .0001), and postoperative time to resumption of regular diet (p < .0001) were all significantly decreased in the poststandardization group. There were no complications or readmissions in either group.
CONCLUSION
The standardized pathway resulted in shorter length of stay, decreased narcotic use, decreased time to regular diet, and decreased time to ambulation with no increase in complication rates.
背景
标准化路径可减少变异性，提高结果和安全性。
目的
本文旨在评估标准化术后护理路径与个别外科医生偏好的结果。
方法
对标准化前后的患者进行了回顾性研究。纳入年龄在 10-21 岁之间、因青少年特发性脊柱侧凸（ICD-9 代码 737.30）住院行后路脊柱融合术（CPT 代码 22630）的患者。研究纳入了标准化前组（25 例患者），时间为 2010 年 4 月 1 日至 2011 年 3 月 30 日，标准化后组（25 例患者），时间为 2014 年 4 月 1 日至 2015 年 3 月 30 日。排除标准为肾病、癫痫、神经障碍或术后并发症导致常规治疗改变，包括肠梗阻或体温高于 102°F。使用 Wilcoxon 符号秩检验对数据进行分析，显著性水平设为 p <.001。
结果
标准化后组的住院时间（p =.0166）、下床活动时间（p <.0001）、自控镇痛使用（p <.0001）和术后恢复正常饮食时间（p <.0001）均显著缩短。两组均无并发症或再入院。
结论
标准化路径可缩短住院时间，减少阿片类药物使用，缩短恢复正常饮食时间和下床活动时间，而不会增加并发症发生率。
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