Jt Comm J Qual Patient Saf. 2021 Feb;47(2):99-106. doi: 10.1016/j.jcjq.2020.10.003. Epub 2020 Oct 22.
Regionalization of care has increased interhospital transfers (IHTs) of nontraumatic intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) to specialized centers yet exposes patients to the latent risks inherent to IHT. The researchers examined how a multimodal quality improvement intervention affected quality and safety measures for patients with ICH or SAH exposed to IHT.
Pre and post analyses of timeliness, effectiveness, and communication outcome measures were performed for patients transferred to an urban, academic center with nontraumatic ICH/SAH following implementation of a multimodal intervention. Intervention components included clinical practice guideline dissemination, IHT process redesign, electronic patient arrival notification, electronic imaging exchange, and electronic health record improvements. Three months of preintervention outcomes were compared to six months of postintervention outcomes to assess impact and sustainability of the intervention; t-tests and chi-square tests were used to compare continuous and proportional outcomes, respectively.
The IHT study population included 106 patients (37 preintervention, 69 postintervention). Significant improvements were observed in timeliness outcomes, including emergency department (ED) time to admission order (preintervention median: 66 minutes vs. postintervention: 33 minutes, p = 0.008), ED boarding time (preintervention median: 223 minutes vs. postintervention: 93 minutes, p = 0.001), and ED length of stay (preintervention median: 300 minutes vs. postintervention: 150 minutes, p ≤ 0.0001). Verbal communication between ED and neurocritical care clinicians prior to IHT improved from 40.0% preintervention to 90.9% postintervention.
Application of scripted quality improvement interventions as part of the IHT process is feasible and effective at improving the timeliness of care and communication of critical information in patients with nontraumatic ICH/SAH.
医疗区域化使得非创伤性颅内出血（ICH）和蛛网膜下腔出血（SAH）患者的院内转院（IHT）增加，并转移到专门的中心，但这使患者面临潜在的 IHT 固有风险。研究人员研究了一种多模式质量改进干预措施如何影响暴露于 IHT 的 ICH 或 SAH 患者的质量和安全措施。
在实施多模式干预后，对转移到城市学术中心的非创伤性 ICH/SAH 患者的及时性、有效性和沟通结果测量进行了预分析和后分析。干预措施包括临床实践指南的传播、IHT 流程重新设计、患者到达通知的电子系统、电子成像交换和电子健康记录的改进。将干预前三个月的结果与干预后六个月的结果进行比较，以评估干预的影响和可持续性；使用 t 检验和卡方检验分别比较连续和比例结果。
IHT 研究人群包括 106 名患者（37 名干预前，69 名干预后）。在及时性结果方面观察到显著改善，包括急诊科（ED）至入院医嘱的时间（干预前中位数：66 分钟与干预后：33 分钟，p=0.008）、ED 留观时间（干预前中位数：223 分钟与干预后：93 分钟，p=0.001）和 ED 住院时间（干预前中位数：300 分钟与干预后：150 分钟，p ≤ 0.0001）。在 IHT 之前，ED 和神经重症监护临床医生之间的口头沟通从干预前的 40.0%提高到干预后的 90.9%。
作为 IHT 流程的一部分，应用脚本化质量改进干预措施是可行且有效的，可提高非创伤性 ICH/SAH 患者的护理及时性和关键信息的沟通。
