多中心实施质量改进措施以减少成人重症监护病房谵妄：一项中断时间序列分析。

Multicentre implementation of a quality improvement initiative to reduce delirium in adult intensive care units: An interrupted time series analysis.

机构信息

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada.

出版信息

J Crit Care. 2024 Jun;81:154524. doi: 10.1016/j.jcrc.2024.154524. Epub 2024 Jan 10.

DOI:10.1016/j.jcrc.2024.154524

PMID:38199062

Abstract

PURPOSE

The ABCDEF bundle may improve delirium outcomes among intensive care unit (ICU) patients, however population-based studies are lacking. In this study we evaluated effects of a quality improvement initiative based on the ABCDEF bundle in adult ICUs in Alberta, Canada.

MATERIAL AND METHODS

We conducted a pre-post, registry-based clinical trial, analysed using interrupted time series methodology. Outcomes were examined via segmented linear regression using mixed effects models. The main data source was a population-based electronic health record.

RESULTS

44,405 consecutive admissions (38,400 unique patients) admitted to 15 general medical/surgical and/or neurologic adult ICUs between 2014 and 2019 were included. The proportion of delirium days per ICU increased from 30.24% to 35.31% during the pre-intervention period. After intervention implementation it decreased significantly (bimonthly decrease of 0.34%, 95%CI 0.18-0.50%, p < 0.01) from 33.48% (95%CI 29.64-37.31%) in 2017 to 28.74% (95%CI 25.22-32.26%) in 2019. The proportion of sedation days using midazolam demonstrated an immediate decrease of 7.58% (95%CI 4.00-11.16%). There were no significant changes in duration of invasive ventilation, proportion of partial coma days, ICU mortality, or potential adverse events.

CONCLUSIONS

An ABCDEF delirium initiative was implemented on a population-basis within adult ICUs and was successful at reducing the prevalence of delirium.

摘要

目的

ABCDEF 集束干预可能改善重症监护病房（ICU）患者的谵妄结局，但目前缺乏基于人群的研究。本研究评估了基于 ABCDEF 集束的质量改进措施在加拿大艾伯塔省成人 ICU 中的效果。

材料和方法

我们进行了一项前后对照、基于注册的临床试验，采用中断时间序列方法进行分析。使用混合效应模型的分段线性回归来评估结果。主要数据来源是基于人群的电子健康记录。

结果

纳入了 2014 年至 2019 年间 15 个普通内科/外科和/或神经科成人 ICU 连续收治的 44405 例（38400 例）患者。ICU 谵妄天数的比例在干预前期间从 30.24%增加到 35.31%。干预实施后，它显著下降（每两个月下降 0.34%，95%CI 0.18-0.50%，p<0.01），从 2017 年的 33.48%（95%CI 29.64-37.31%）降至 2019 年的 28.74%（95%CI 25.22-32.26%）。咪达唑仑镇静天数立即下降了 7.58%（95%CI 4.00-11.16%）。侵入性通气时间、部分昏迷天数、ICU 死亡率或潜在不良事件均无显著变化。