Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
Pediatric Cardiology, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada.
BMJ Open Qual. 2022 May;11(2). doi: 10.1136/bmjoq-2022-001815.
Driveline infections (DLIs) are a common adverse event in patients on ventricular assist devices (VADs) with incidence ranging from 14% to 59%. DLIs have an impact on patients and the healthcare system with efforts to prevent DLIs being essential. Prior to our intervention, our program had no standard driveline management presurgery and postsurgery. The purpose of this Quality Improvement (QI) initiative was to reduce DLIs and related admissions among patients with VAD within the first year post implant.
In anticipation of the QI project, we undertook a review of the programs' current driveline management procedures and completed a survey with patients with VAD to identify current barriers to proper driveline management. Retrospective data were collected for a pre-QI intervention baseline comparison group, which included adult patients implanted with a durable VAD between 1 January 2017 and 31 July 2018. A three-pronged care pathway (CP) was initiated among patients implanted during August 2018 to July 2019. The CP included standardised intraoperative, postoperative and predischarge teaching initiatives and tracking. Using statistical process control methods, DLIs and readmissions in the first year post implant were compared between patients in the CP group and non-CP patients. P-charts were used to detect special cause variation.
A higher proportion of CP group patients developed a DLI in the first year after implant (52% vs 32%). None developed a DLI during the index admission, which differed from the non-CP group and met criteria for special cause variation. There was a downward trend in cumulative DLI-related readmissions among CP group patients (55% vs 67%). There was no association between CP compliance and development of DLIs within 1 year post implant.
The CP did not lead to a reduction in the incidence of DLIs but there was a decrease in the proportion of patients with DLIs during their index admission and those readmitted for DLIs within 1 year post implant. This suggests that the CP played a role in decreasing the impact of DLIs in this patient population. However, given the short time period of follow-up longer follow-up will be required to look for sustained effects.
在接受心室辅助装置（VAD）治疗的患者中，导管相关感染（DLIs）是一种常见的不良事件，发生率为 14%至 59%。DLIs 对患者和医疗系统都有影响，因此努力预防 DLIs 是至关重要的。在我们的干预之前，我们的项目在术前和术后都没有标准的导管管理。本质量改进（QI）计划的目的是降低植入后第一年 VAD 患者的 DLI 发生率和相关住院率。
在 QI 项目实施之前，我们对该项目目前的导管管理程序进行了审查，并对 VAD 患者进行了调查，以确定目前导管管理不当的障碍。回顾性收集了 2017 年 1 月 1 日至 2018 年 7 月 31 日期间植入的耐用型 VAD 患者的基线数据作为 QI 干预前的比较组。2018 年 8 月至 2019 年 7 月期间，对植入患者启动了三管齐下的护理路径（CP）。CP 包括标准化的术中、术后和出院前的教育计划和跟踪。使用统计过程控制方法，比较 CP 组和非 CP 组患者在植入后第一年的 DLI 和再入院率。P 图用于检测特殊原因的变化。
CP 组患者在植入后第一年发生 DLI 的比例较高（52% vs 32%）。在指数住院期间，没有人发生 DLI，这与非 CP 组不同，符合特殊原因变化的标准。CP 组患者的 DLI 相关再入院率呈下降趋势（55% vs 67%）。CP 依从性与植入后 1 年内发生 DLI 无关。
CP 并未降低 DLI 的发生率，但降低了 DLI 指数住院患者的比例，以及植入后 1 年内因 DLI 再入院的患者比例。这表明 CP 在降低该患者群体的 DLI 影响方面发挥了作用。然而，鉴于随访时间较短，需要更长的随访时间来寻找持续的效果。
