BMJ子刊:在阿根廷的儿科重症监护病房中改善交接和减少不良事件的计划的实施:一项逐步楔形试验

2021
05/09

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BMJ Qual. Saf.: 在阿根廷的儿科重症监护病房中改善交接和减少不良事件的计划的实施:一项逐步楔形试验 分享智慧 共同成长 

BMJ Qual. Saf.:

在阿根廷的儿科重症监护病房中改善交接和减少不良事件的计划的实施:一项逐步楔形试验

 

 



分享智慧

共同成长

摘要

背景

有关严格评估交接改进计划的有效性来改善交接质量和不良事件(AE)的研究很少,并且都没有在中低收入国家进行。我们旨在评估实施交接计划在降低儿童重症监护病房(PICU)AE频率中的效果。

方法

在五家阿根廷医院的六个PICU中进行基于现场,集群随机,渐进式楔形试验,每月入组> 20人。该研究于2018年7月至2019年5月进行,对照期间所有单位至少参与3个月,在干预期间至少参与4个月。干预措施包括西班牙语版本的I-PASS交接包,包括使用助记符的书面和口头交接,带有团队合作培训的入门讲习班,宣传活动,模拟演习,观察和交接的标准化反馈。使用触发工具方法对病历(MR)进行了审查,以识别AE(主要结局)。通过直接观察评估交班依从性和持续时间。

结果

我们回顾了1465例MR,对照期为767例,干预期为698例。我们没有观察到每1000天住院期间可预防的AE发生率的差异(对照60.4(37.5–97.4)与干预措施60.4(33.2–109.9),p = 0.99,风险比:1.0(0.74–1.34)),并且没有AE类型的更改。我们评估了841次交班:对照期内为396次交班,干预期间为445次。干预组对口头和书面交接中所有项目的依从性明显更高。我们观察到两个时期的交班时间均无差异(对照35.7分钟(29.6-41.8)与干预34.7分钟(26.5-42.1);差异1.43分钟(95%CI -2.63至5.49,p = 0.49))。医务人员对改善沟通的看法没有改变。

结论 在实施I-PASS捆绑包之后,对交接项目的遵守情况得到了改善。但是,在AE的频率或增强沟通的感觉上没有观察到差异。

Abstract

Background 

There are only a few studies on handoff quality and adverse events (AEs) rigorously evaluating handoff improvement programmes’ effectiveness. None of them have been conducted in low and middle-income countries. We aimed to evaluate the effect of a handoff programme implementation in reducing AE frequency in paediatric intensive care units (PICUs).

Methods 

Facility-based, cluster-randomised, stepped-wedge trial in six Argentine PICUs in five hospitals, with >20 admissions per month. The study was conducted from July 2018 to May 2019, and all units at least were involved for 3 months in the control period and 4 months in the intervention period. The intervention comprised a Spanish version of the I-PASS handoff bundle consisting of a written and verbal handoff using mnemonics, an introductory workshop with teamwork training, an advertising campaign, simulation exercises, observation and standardised feedback of handoffs. Medical records (MR) were reviewed using trigger tool methodology to identify AEs (primary outcome). Handoff compliance and duration were evaluated by direct observation.

Results 

We reviewed 1465 MRs: 767 in the control period and 698 in the intervention period. We did not observe differences in the rates of preventable AE per 1000 days of hospitalisation (control 60.4 (37.5–97.4) vs intervention 60.4 (33.2–109.9), p=0.99, risk ratio: 1.0 (0.74–1.34)), and no changes in the categories or AE types. We evaluated 841 handoffs: 396 in the control period and 445 in the intervention period. Compliance with all items in the verbal and written handoffs was significantly higher in the intervention group. We observed no difference in the handoff time in both periods (control 35.7 min (29.6–41.8) vs intervention 34.7 min (26.5–42.1); difference 1.43 min (95% CI −2.63 to 5.49, p=0.49)). The providers’ perception of improved communication did not change.

Conclusions 

After the implementation of the I-PASS bundle, compliance with handoff items improved. Nevertheless, no differences were observed in the AEs’ frequency or the perception of enhanced communication.


THE

END

本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:nanxingjun@hmkx.cn
关键词:
period,BMJ,阿根廷,MR

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