Gold Andrew K, Huffenberger Ann, Lane-Fall Meghan, Pascual Lopez Jose L, Rock Kristen C
Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA.
Department of Nursing, Hospital of the University of Pennsylvania, Philadelphia, PA.
Crit Care Explor. 2021 Sep 10;3(9):e0536. doi: 10.1097/CCE.0000000000000536. eCollection 2021 Sep.
The objectives of this study were to codify the events triggering bedside recording and to report the types of performance issues identified that were then used to inform dedicated ICU quality improvement efforts.
This is a retrospective descriptive analysis of a video review program conducted at a single institution from July 2016 to November 2019.
Surgical and Trauma ICU at a single urban academic quaternary care center.
All patients admitted to the surgical and trauma ICU between July 2016 and November 2019 were eligible for the study as all ICU beds in our health system institutions are equipped with closed circuit video/audio monitoring. Through an institutional review board approved program, any event triggering the immediate bedside presence of a provider in the ICU is routinely recorded at the discretion of the care team or tele-intensivist.
A database of these events was created over a 3-year period, and cases were reviewed for content, quality improvement, and educational opportunities. Select recordings were analyzed and shared at multidisciplinary/multiprofessional video review sessions.
There were 286 critical events video recorded and reviewed in the ICUs between July 2016 and November 2019. The most commonly recorded events included: cardiopulmonary arrests ( = 75), intubations ( = 71), and acute clinical decompensation triggered by nonreassuring vital signs ( = 57) or arrhythmias ( = 13). Of these recordings, 59 were shared at video review conferences, where quality of care was assessed and thematic opportunities for improvement were characterized. Recurrent quality improvement themes that were identified included adherence to protocols, the importance of teamwork and closed-loop communication, clearly designated team leadership, and the use of universal precautions.
Video review in the ICU is feasible and presents valuable opportunities for quality improvement and educational discussions.
本研究的目的是编纂触发床边记录的事件，并报告所识别的性能问题类型，这些问题随后被用于为重症监护病房（ICU）专门的质量改进工作提供信息。
这是一项对2016年7月至2019年11月在单一机构进行的视频回顾项目的回顾性描述性分析。
一家城市学术四级医疗中心的外科和创伤重症监护病房。
2016年7月至2019年11月期间入住外科和创伤重症监护病房的所有患者均符合本研究条件，因为我们卫生系统机构的所有重症监护病床都配备了闭路视频/音频监控。通过机构审查委员会批准的项目，任何触发提供者立即到ICU床边的事件都由护理团队或远程重症监护专家酌情进行常规记录。
在3年期间创建了这些事件的数据库，并对病例进行内容、质量改进和教育机会方面的审查。选择的记录在多学科/多专业视频回顾会议上进行分析和分享。
2016年7月至2019年11月期间，重症监护病房共记录并回顾了286个关键事件视频。最常记录的事件包括：心肺骤停（n = 75）、插管（n = 71）以及由生命体征不稳定（n = 57）或心律失常（n = 13）引发的急性临床失代偿。在这些记录中，59个在视频回顾会议上进行了分享，会上评估了护理质量并确定了改进的主题机会。所识别的反复出现的质量改进主题包括遵守协议、团队合作和闭环沟通的重要性、明确指定的团队领导以及使用通用预防措施。
重症监护病房的视频回顾是可行的，为质量改进和教育讨论提供了宝贵机会。
