Andrea Hetherington, Leisa Bauer, Sheree Rablin, Karen Hay, Faye Jordan
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引用次数: 0
Abstract
Background: Acute wheeze is a common emergency department presentation among pre-school aged children. Innovative models of care that safely optimise treatment and streamline patient flow are needed. A nurse-led stretching of inhaled salbutamol pathway was introduced to enable nurses to independently manage bronchodilator weaning. This study evaluated its impact on length of stay within a children's short term treatment area.
Methods: A single-site controlled pre-post retrospective cohort study was conducted comparing children aged 1-5 years with wheeze admitted to the children's short term treatment area before and after the implementation of the nurse-led stretching of inhaled salbutamol pathway. A gastroenteritis cohort admitted during the same periods served as a non-equivalent control group to assess temporal confounding. The primary outcome was length of stay; secondary outcome included admission to the paediatric service.
Results: The wheeze cohort included 533 children. Median length of stay was similar pre- and post-implementation (420 vs 429 min; p = 0.48). However, escalation to a medical officer or nurse practitioner significantly declined post-implementation (from 70.9% to 49.8%; p < 0.001), while utilisation of criteria-led discharge increased (from 41.0% to 64.3%; p < 0.001).
Conclusions: The nurse-led stretching of inhaled salbutamol pathway did not reduce length of stay but demonstrated comparable outcomes to conventional care. This model appears safe and may enhance workforce capacity and ED efficiency.
背景：急性喘息是学龄前儿童常见的急诊科表现。需要安全优化治疗和简化病人流程的创新护理模式。引入护士主导的吸入沙丁胺醇路径拉伸，使护士能够独立管理支气管扩张剂脱机。本研究评估了其对儿童短期治疗区域内停留时间的影响。方法：采用单点对照前后回顾性队列研究，对1-5岁儿童短期治疗区收治的喘息患儿在实施护士主导的吸入沙丁胺醇途径拉伸前后进行比较。在同一时期入院的肠胃炎队列作为非等效对照组来评估时间混淆。主要指标是住院时间；次要结果包括进入儿科服务。结果：喘息队列包括533名儿童。实施前和实施后的中位住院时间相似（420 vs 429 min; p = 0.48）。然而，升级到医务人员或执业护士的患者在实施后显著下降(从70.9%降至49.8%；p 结论：护士主导的吸入沙丁胺醇途径拉伸并没有减少住院时间，但显示出与传统护理相当的结果。这种模式似乎是安全的，可以提高劳动力能力和ED效率。
期刊介绍：
Australasian Emergency Care is an international peer-reviewed journal dedicated to supporting emergency nurses, physicians, paramedics and other professionals in advancing the science and practice of emergency care, wherever it is delivered. As the official journal of the College of Emergency Nursing Australasia (CENA), Australasian Emergency Care is a conduit for clinical, applied, and theoretical research and knowledge that advances the science and practice of emergency care in original, innovative and challenging ways. The journal serves as a leading voice for the emergency care community, reflecting its inter-professional diversity, and the importance of collaboration and shared decision-making to achieve quality patient outcomes. It is strongly focussed on advancing the patient experience and quality of care across the emergency care continuum, spanning the pre-hospital, hospital and post-hospital settings within Australasia and beyond.
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