根据国际标准组织协议的重症儿科患者护理质量和安全的关键过程和结果指标:一项为期四年的随访研究

IF 1 4区医学 Q3 EMERGENCY MEDICINE

Signa Vitae Pub Date : 2023-01-01 DOI:10.22514/sv.2023.085

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引用次数: 0

摘要

欧洲重症医学会(ESICM)提出了危重病人护理的九项质量和安全指标。本研究的目的是检查根据国际标准组织(ISO)协议在希腊儿科重症监护室(PICU)选择的关键过程和结果指标(KPOIs)。在一项为期四年的观察性队列研究(2017-2020)中，根据观察-计划-执行-研究-行动(OPDSA)周期，采用逐步方法检查了两个结构，一个过程和四个结果指标。两个结构指标——icu满足国家提供重症监护的要求和24小时咨询师的可用性——是创建PICU的要求，并被认为是护理标准。其中一项流程指标——标准化交接程序由手写(2017-2018)转变为电子形式(2019-2020)，四年合规率达到100%。2017年、2018年、2019年和2020年共收治96例、85例、103例和94例患儿，儿童死亡风险III-24 h中位评分分别为10(6.25-17)、10(6-13)、8(5-13)和8(6.75-12)。死亡率分别为24%、11.8%、17.5%、16%，标准化死亡率(SMR)分别为1.42、0.92、1.56、1.33。2017年和2018年无早期(出院后48小时)再入院记录，2019年仅1例(0.8%)，2020年无一例。导管相关血流感染率分别为1.37:1000、1.37:1000、1.26:1000、1.39:1000。2019年非计划拔管率为10.30%，2020年为5.72%和3.91:1000通气日。总之，我们单位的ISO实施是内部PICU审核和外部基准测试的触发因素。OPDSA循环，在一个迭代的进化循环中，每次跟随一小步，促进了我们的行动。在我们的研究中检查的大多数kpoi都在国际picu参考值范围内。

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Key process and outcome indicators on quality and safety of care for critically ill pediatric patients according to international standard organization protocols: a four-year follow-up study

The European Society of Intensive Care Medicine (ESICM) suggests nine quality and safety indicators of care for critically ill patients. The aim of the present study was to examine the Key Process and Outcome Indicators (KPOIs) chosen according to International Standard Organization (ISO) protocols in a Greek Pediatric Intensive Care Unit (PICU). Two structure, one process, and four outcome indicators were examined in a stepwise approach according to Observe-Plan-Do-Study-Act (OPDSA) cycles, in an observational four-year cohort study (2017–2020). Two structure indicators—that ICUs fulfil national requirements to provide intensive care and 24-h consultant availability were requirements for the creation of the PICU and considered standards of care. One process indicator—Standardized Handover Procedure was transformed from handwritten (2017–2018) into electronic form (2019–2020) and 100% compliance rates throughout the four years were recorded. 96, 85, 103 and 94 patients were admitted in 2017, 2018, 2019 and 2020 with median (IQR) Pediatric Risk of Mortality III-24 h scores of 10 (6.25–17), 10 (6–13), 8 (5–13) and 8 (6.75–12), respectively. Mortality rates were 24%, 11.8%, 17.5%, 16%, and Standardized Mortality Ratio (SMR) were 1.42, 0.92, 1.56 and 1.33, correspondingly. No early (<48 h after PICU discharge) readmissions were recorded for 2017 and 2018, only 1 in 2019 (0.8%) and none in 2020. Catheter Related Bloodstream Infection rates were 1.37:1000, 1.37:1000, 1.26:1000 and 1.39:1000 catheter days, respectively. Unplanned extubation rate was 10.30% in 2019 and 5.72% and 3.91:1000 ventilation days in 2020. In conclusion, ISO implementation of our unit was the trigger for internal PICU audit and external benchmarking. OPDSA cycles, following small steps at a time, in an iterate cycle of evolution, facilitated our actions. The majority of the KPOIs examined in our study was within international PICUs reference values.

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来源期刊

Signa Vitae 医学-急救医学

CiteScore

1.30

自引率

9.10%

发文量

审稿时长

3 months

期刊介绍： Signa Vitae is a completely open-access，peer-reviewed journal dedicate to deliver the leading edge research in anaesthesia, intensive care and emergency medicine to publics. The journal’s intention is to be practice-oriented, so we focus on the clinical practice and fundamental understanding of adult, pediatric and neonatal intensive care, as well as anesthesia and emergency medicine. Although Signa Vitae is primarily a clinical journal, we welcome submissions of basic science papers if the authors can demonstrate their clinical relevance. The Signa Vitae journal encourages scientists and academicians all around the world to share their original writings in the form of original research, review, mini-review, systematic review, short communication, case report, letter to the editor, commentary, rapid report, news and views, as well as meeting report. Full texts of all published articles, can be downloaded for free from our web site.