多方面实施和维持院前麻醉协议：直升机紧急医疗服务 2115 例患者的回顾性分析。
Multifaceted implementation and sustainability of a protocol for prehospital anaesthesia: a retrospective analysis of 2115 patients from helicopter emergency medical services.
机构信息
Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vesikuja 9, 01530, Vantaa, Finland.
出版信息
Scand J Trauma Resusc Emerg Med. 2023 Apr 30;31(1):21. doi: 10.1186/s13049-023-01086-w.
BACKGROUND
Prehospital emergency anaesthesia (PHEA) is a high-risk procedure. We developed a prehospital anaesthesia protocol for helicopter emergency medical services (HEMS) that standardises the process and involves ambulance crews as active team members to increase efficiency and patient safety. The aim of the current study was to evaluate this change and its sustainability in (i) on-scene time, (ii) intubation first-pass success rate, and (iii) protocol compliance after a multifaceted implementation process.
METHODS
The protocol was implemented in 2015 in a HEMS unit and collaborating emergency medical service systems. The implementation comprised dissemination of information, lectures, simulations, skill stations, academic detailing, and cognitive aids. The methods were tailored based on implementation science frameworks. Data from missions were gathered from mission databases and patient records.
RESULTS
During the study period (2012-2020), 2381 adults underwent PHEA. The implementation year was excluded; 656 patients were analysed before and 1459 patients after implementation of the protocol. Baseline characteristics and patient categories were similar. On-scene time was significantly redused after the implementation (median 32 [IQR 25-42] vs. 29 [IQR 21-39] minutes, p < 0.001). First pass success rate increased constantly during the follow-up period from 74.4% (95% CI 70.7-77.8%) to 97.6% (95% CI 96.7-98.3%), p = 0.0001. Use of mechanical ventilation increased from 70.6% (95% CI 67.0-73.9%) to 93.4% (95% CI 92.3-94.8%), p = 0.0001, and use of rocuronium increased from 86.4% (95% CI 83.6-88.9%) to 98.5% (95% CI 97.7-99.0%), respectively. Deterioration in compliance indicators was not observed.
CONCLUSIONS
We concluded that clinical performance in PHEA can be significantly improved through multifaceted implementation strategies.
背景
院前急救麻醉（PHEA）是一项高风险的程序。我们为直升机紧急医疗服务（HEMS）制定了院前麻醉协议，该协议使流程标准化，并让救护人员作为积极的团队成员参与其中，以提高效率和患者安全性。本研究的目的是评估经过多方面实施后（i）现场时间、（ii）插管首次成功率和（iii）协议依从性的变化及其可持续性。
方法
该协议于 2015 年在 HEMS 单位和合作的紧急医疗服务系统中实施。实施包括信息传播、讲座、模拟、技能站、学术细化和认知辅助。方法根据实施科学框架进行定制。任务数据从任务数据库和患者记录中收集。
结果
在研究期间（2012-2020 年），2381 名成年人接受了 PHEA。实施年份被排除在外；在协议实施前分析了 656 例患者，在协议实施后分析了 1459 例患者。基线特征和患者类别相似。实施后现场时间显著减少（中位数 32[IQR 25-42] 分钟比 29[IQR 21-39] 分钟，p<0.001）。首次通过成功率在随访期间持续增加，从 74.4%（95%CI 70.7-77.8%）增加到 97.6%（95%CI 96.7-98.3%），p=0.0001。机械通气使用率从 70.6%（95%CI 67.0-73.9%）增加到 93.4%（95%CI 92.3-94.8%），p=0.0001，罗库溴铵使用率从 86.4%（95%CI 83.6-88.9%）增加到 98.5%（95%CI 97.7-99.0%），p=0.0001。未观察到依从性指标的恶化。
结论
我们得出结论，通过多方面的实施策略，可以显著提高 PHEA 的临床性能。
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