Clinical Services, South Metropolitan Health Service, Murdoch, Western Australia, Australia
The University of Notre Dame Australia, Fremantle, Australia.
BMJ Open Qual. 2024 Nov 4;13(4):e002940. doi: 10.1136/bmjoq-2024-002940.
Reducing the prevalence of hospital-acquired complications (HACs) is paramount for both patient safety and hospital financial performance because of its impact on patient's recovery and health service delivery by diverting resources away from other core patient care activities. While numerous reports are available in the literature for projects that successfully reduce specific HAC, questions remain about the sustainability of this isolated approach and there may be benefits for more wholistic programmes that aim to align prevention strategies across a hospital. This study describes such a programme that uses evidence and theories in the literature to achieve and sustain a reduction in HACs in an Australian local health service between 2019 and 2022.
An organisation-wide HACs Reduction Programme underpinned by a 3-pillar strategic framework (complete documentation, accurate coding, clinical effectiveness) and a 5-year roadmap to clinical excellence was developed. Priorities were identified through Pareto analysis and aligned at organisational, service and specialty levels. The Institute for Healthcare Improvement (IHI) 90-day cycle was modified to implement contextualised evidence-based interventions supported by the application of the Awareness, Desire, Knowledge, Ability and Reinforcement change management model. Under this wholistic umbrella, specific projects were data-driven, evidence-based and outcome-oriented to promote clinical engagement and a continuous improvement culture.
Overall mean HAC rate per 10 000 episodes of care decreased from a baseline of 459.5 across 2017 and 2018 to 363.1 in 2019 and remained lower through to the end of 2022 indicating sustained improvement in performance.
A wholistic approach to reduce HACs increased the likelihood of multidisciplinary integration for contextualised strategies and interventions. Improvement work, particularly in relation to patient outcomes, is a dynamic process that needs to be intentionally cultivated, targeted and coordinated. The modified IHI 90-day cycle proved to be an effective tool for implementation that contributed to sustained change.
减少医院获得性并发症（HAC）的发生率对于患者安全和医院财务绩效至关重要，因为它会影响患者的康复和医疗服务提供，从而使资源从其他核心患者护理活动中转移。虽然文献中有许多关于成功降低特定 HAC 的项目的报告，但对于这种孤立的方法的可持续性仍存在疑问，并且对于旨在使医院内预防策略保持一致的更全面的计划可能会有好处。本研究描述了这样一个项目，该项目使用文献中的证据和理论来实现并维持澳大利亚当地医疗服务机构在 2019 年至 2022 年期间 HAC 的减少。
制定了一个以三支柱战略框架（完整的文件记录、准确的编码、临床效果）为基础的全组织范围的 HAC 减少计划，以及一个实现卓越临床水平的五年路线图。通过帕累托分析确定了优先事项，并在组织、服务和专业层面上进行了协调。对改善医疗保健协会（IHI）的 90 天周期进行了修改，以实施基于应用意识、愿望、知识、能力和强化的改变管理模型的基于证据的干预措施。在这个全面的框架下，具体项目是数据驱动的、基于证据的和面向结果的，以促进临床参与和持续改进文化。
在 2017 年和 2018 年每 10000 个治疗事件的平均 HAC 率为 459.5 的基线水平，到 2019 年下降到 363.1，并一直持续到 2022 年底，表明绩效持续改善。
采用整体方法来减少 HAC 增加了多学科整合的可能性，以制定基于背景的策略和干预措施。改善工作，特别是与患者结果有关的工作，是一个动态的过程，需要有目的地培养、瞄准和协调。经过修改的 IHI 90 天周期被证明是一种有效的实施工具，有助于持续的变革。
