Griffith D, Hampton D, Switzer M, Daniels J
St Joseph Hospital, Lexington, Ky, USA.
Am J Crit Care. 1996 Sep;5(5):346-52.
To illustrate, using a literature review and CareMAPs, how care coordination and implementation of standard protocols can impact clinical outcomes for open heart surgery patients.
A CareMAP for open heart surgery patients was developed by a multidisciplinary team. To evaluate the effectiveness of CareMAP implementation and specific quality improvement efforts, a pilot study was done that focused on increasing activity levels, decreasing ventilator time, and decreasing the frequency of arterial blood gas sampling for a sample of 55 open heart surgery patients. A rapid recovery program was developed based on the results of this pilot study. A multidisciplinary continuous quality improvement team was developed to focus on three primary areas: ventilator weaning time, activity regimens, and early transfer to the open heart surgery step-down unit. Forty-nine open heart surgery patients were included in the initial program evaluation.
The frequency of arterial blood gas sampling decreased from an average of 5.8 per patient to an average of 3.9 per patient. Postoperative length of stay also decreased by 1.3 days for diagnosis related group 106 patients, and 3.7 days for diagnosis related group 107 patients. Results of the pilot study demonstrated additional opportunities for improving the care of open heart surgery patients. Using the rapid recovery program, the average ventilator time decreased by 4.4 hours per patient. The average postoperative length of stay decreased to 4.7 days.
Through the quality improvement process and through the use of CareMAPs and specific protocols, the recovery of open heart surgery patients was facilitated.
通过文献综述和护理流程图（CareMAPs），阐述护理协调和标准方案的实施如何影响心脏直视手术患者的临床结局。
一个多学科团队为心脏直视手术患者制定了护理流程图。为评估护理流程图实施的有效性和具体的质量改进措施，开展了一项试点研究，重点关注55名心脏直视手术患者样本的活动水平提高、呼吸机使用时间缩短以及动脉血气采样频率降低。基于该试点研究结果制定了快速康复计划。成立了一个多学科持续质量改进团队，专注于三个主要领域：呼吸机撤机时间、活动方案以及早期转至心脏直视手术降级护理单元。初始项目评估纳入了49名心脏直视手术患者。
动脉血气采样频率从平均每位患者5.8次降至平均每位患者3.9次。诊断相关组106的患者术后住院时间也缩短了1.3天，诊断相关组107的患者缩短了3.7天。试点研究结果表明在改善心脏直视手术患者护理方面还有其他机会。采用快速康复计划后，每位患者的平均呼吸机使用时间减少了4.4小时。术后平均住院时间降至4.7天。
通过质量改进过程以及使用护理流程图和具体方案，促进了心脏直视手术患者的康复。
