Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain; CIBERES, Spain.
Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain.
Int J Med Inform. 2024 Apr;184:105352. doi: 10.1016/j.ijmedinf.2024.105352. Epub 2024 Feb 3.
Evidence-based care processes are not always applied at the bedside in critically ill patients. Numerous studies have assessed the impact of checklists and related strategies on the process of care and patient outcomes. We aimed to evaluate the effects of real-time random safety audits on process-of-care and outcome variables in critical care patients.
This prospective study used data from the clinical information system to evaluate the impact of real-time random safety audits targeting 32 safety measures in two intensive care units during a 9-month period. We compared endpoints between patients attended with safety audits and those not attended with safety audits. The primary endpoint was mortality, measured by Cox hazard regression after full propensity-score matching. Secondary endpoints were the impact on adherence to process-of-care measures and on quality indicators.
We included 871 patients; 228 of these were attended in ≥ 1 real-time random safety audits. Safety audits were carried out on 390 patient-days; most improvements in the process of care were observed in safety measures related to mechanical ventilation, renal function and therapies, nutrition, and clinical information system. Although the group of patients attended in safety audits had more severe disease at ICU admission [APACHE II score 21 (16-27) vs. 20 (15-25), p = 0.023]; included a higher proportion of surgical patients [37.3 % vs. 26.4 %, p = 0.003] and a higher proportion of mechanically ventilated patients [72.8 % vs. 40.3 %, p < 0.001]; averaged more days on mechanical ventilation, central venous catheter, and urinary catheter; and had a longer ICU stay [12.5 (5.5-23.3) vs. 2.9 (1.7-5.9), p < 0.001], ICU mortality did not differ significantly between groups (19.3 % vs. 18.8 % in the group without safety rounds). After full propensity-score matching, Cox hazard regression analysis showed real-time random safety audits were associated with a lower risk of mortality throughout the ICU stay (HR 0.31; 95 %CI 0.20-0.47).
Real-time random safety audits are associated with a reduction in the risk of ICU mortality. Exploiting data from the clinical information system is useful in assessing the impact of them on the care process, quality indicators, and mortality.
在危重病患者中，循证护理流程并不总是在床边实施。许多研究评估了清单和相关策略对护理过程和患者结局的影响。我们旨在评估实时随机安全审核对重症监护患者护理过程和结局变量的影响。
这项前瞻性研究使用临床信息系统的数据，评估了在 9 个月期间对 2 个重症监护病房的 32 项安全措施进行实时随机安全审核的影响。我们比较了接受安全审核和未接受安全审核患者的终点。主要终点是死亡率，采用完全倾向评分匹配后的 Cox 风险回归进行测量。次要终点是对护理过程措施和质量指标的影响。
我们纳入了 871 例患者；其中 228 例接受了≥1 次实时随机安全审核。进行了 390 个患者日的安全审核；在与机械通气、肾功能和治疗、营养和临床信息系统相关的安全措施方面观察到了最多的护理过程改进。尽管接受安全审核的患者在 ICU 入院时的疾病更严重[APACHE II 评分 21（16-27）比 20（15-25），p=0.023]；包括更高比例的手术患者[37.3%比 26.4%，p=0.003]和更高比例的机械通气患者[72.8%比 40.3%，p<0.001]；平均机械通气、中心静脉导管和导尿管使用天数更多；ICU 住院时间更长[12.5（5.5-23.3）比 2.9（1.7-5.9），p<0.001]，两组 ICU 死亡率无显著差异（无安全轮班组为 19.3%，安全轮班组为 18.8%）。在完全倾向评分匹配后，Cox 风险回归分析显示，实时随机安全审核与 ICU 住院期间死亡率降低相关（HR 0.31；95%CI 0.20-0.47）。
实时随机安全审核与 ICU 死亡率降低相关。利用临床信息系统的数据评估它们对护理过程、质量指标和死亡率的影响是有用的。
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