让患有复杂疾病的婴儿顺利回家：质量改进工作的经验教训。
Transitioning medically complex infants home: lessons learned from quality improvement efforts.
作者信息
Benscoter Dan, Voos Kristin, Schuler Christine L, Hoberman Andrea J, Kaplan Heather C, Kuhnell Pierce, Lannon Carole M
机构信息
Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
出版信息
J Perinatol. 2025 Mar;45(3):404-410. doi: 10.1038/s41372-024-02189-7. Epub 2024 Dec 14.
OBJECTIVE
Decrease: 1) time from tracheostomy or gastrostomy tube placement to discharge home, and 2) avoidable readmissions within 7 days post-discharge, for medically complex infants.
STUDY DESIGN
Five neonatology units and representatives from Medicaid and Managed Care Organizations participated. Measures included length of stay (LOS) from surgery to discharge, readmissions, and time from surgery to identifying home nursing. We used statistical process control (SPC) methods and bivariate tests for post-hoc before-after comparisons.
RESULT
Among 421 infants, no avoidable readmissions occurred in the final 25 months. LOS and all-cause readmissions were unchanged (SPC). LOS changes were variable, ranging from -39.5 days (tracheostomy and ventilator) to +30.8 days (tracheostomy without ventilator) and not significant. Median time to identify home nursing was 70.1 days (range 2-428).
CONCLUSION
Although lack of skilled home nursing precluded improving transitions from NICU to home in medically complex infants, all avoidable readmissions were eliminated for 25 months.
目的
减少：1）医疗复杂婴儿从气管造口术或胃造口术置管到出院回家的时间，以及2）出院后7天内的可避免再入院情况。
研究设计
五个新生儿科单位以及医疗补助和管理式医疗组织的代表参与其中。测量指标包括从手术到出院的住院时间（LOS）、再入院情况以及从手术到确定家庭护理的时间。我们使用统计过程控制（SPC）方法和双变量检验进行事后前后比较。
结果
在421名婴儿中，在最后25个月内未发生可避免的再入院情况。住院时间和全因再入院情况未发生变化（SPC）。住院时间变化不一，从-39.5天（气管造口术且使用呼吸机）到+30.8天（气管造口术但未使用呼吸机），且无显著差异。确定家庭护理的中位时间为70.1天（范围为2 - 428天）。
结论
尽管缺乏熟练的家庭护理阻碍了医疗复杂婴儿从新生儿重症监护病房（NICU）向家庭的过渡，但在25个月内消除了所有可避免的再入院情况。
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