心脏移植后护理路径对缩短住院时间的影响。
Post-Heart Transplant Care Pathway's Impact on Reducing Length of Stay.
作者信息
Guertin Lisa, Earle Melinda, Dardas Todd, Brown Christopher
机构信息
University of Washington Medical Center, Seattle (Ms Guertin and Dr Dardas); Rush University College of Nursing, Chicago, Illinois (Dr Earle); and Decision Patterns, Oakland, California (Dr Brown).
出版信息
J Nurs Care Qual. 2021;36(4):350-354. doi: 10.1097/NCQ.0000000000000546.
BACKGROUND
Prolonged length of stay (LOS) has undesirable consequences including increased cost, resource consumption, morbidity, and disruptions in hospital flow.
LOCAL PROBLEM
A high-volume heart transplant center in the Pacific Northwest had a mean index hospital LOS of 23 days, with a goal of 10 days according to the institutional heart transplant care pathway.
METHODS
A retrospective, regression analysis was used to identify the factors contributing to LOS of 41 post-heart transplant patients.
INTERVENTIONS
The post-heart transplant care pathway and order set were modified accordingly and reintroduced to the health care team.
RESULTS
Factors contributing to LOS included number of days (1) until the first therapeutic calcineurin inhibitor level, (2) until intravenous diuretics were no longer required, and (3) outside of a therapeutic calcineurin inhibitor range. The interventions reduced the mean LOS by 8 days.
CONCLUSIONS
Increased awareness of LOS, education, and consistent use of care pathways can significantly reduce length of stay.
背景
住院时间延长会产生不良后果，包括成本增加、资源消耗、发病率上升以及医院流程中断。
当地问题
太平洋西北地区的一家大型心脏移植中心，心脏移植患者的平均住院时间为23天，而根据机构心脏移植护理路径，目标住院时间为10天。
方法
采用回顾性回归分析，确定41例心脏移植术后患者住院时间延长的影响因素。
干预措施
相应修改心脏移植护理路径和医嘱集，并重新介绍给医疗团队。
结果
导致住院时间延长的因素包括：（1）直到首次检测到治疗性钙调神经磷酸酶抑制剂水平的天数；（2）直到不再需要静脉使用利尿剂的天数；（3）超出治疗性钙调神经磷酸酶抑制剂范围的天数。干预措施使平均住院时间缩短了8天。
结论
提高对住院时间的认识、进行教育并持续使用护理路径可显著缩短住院时间。
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