建立儿科院内心脏骤停质量改进计划。

IF 1.2 Q3 PEDIATRICS
Pediatric quality & safety Pub Date : 2023-12-12 eCollection Date: 2023-11-01 DOI:10.1097/pq9.0000000000000706
Anya J Freedman, Erik C Madsen, Lia Lowrie
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引用次数: 0

摘要

背景:小儿院内心脏骤停(IHCA)是一种罕见病,死亡率高达 50-55%。心肺复苏(CPR)技术、药物和电疗时机、团队动力、模拟和汇报计划与改善预后有关。本研究旨在通过描述和实施质量改进流程,在传统孤立的儿科复苏团队结构之间进行交叉和协调,从而改善 IHCA 后的治疗效果:我们选择了三种结果测量方法:(方法: 我们选择了三个结果指标:(1)自发性循环恢复(ROSC);(2)IHCA 后 24 小时存活率;(3)出院后存活率。过程结果包括:(1) 使用标准化表格进行热汇报;(2) 使用修订后的表格记录代码;(3) 使用标准化表格向中央应急管理委员会提交正式的代码小组审查报告:结果:在为期 36 个月的研究期间,132 名患者经历了 176 起事件。出院后的存活率从第一年的 33% 上升到第二年的 60%(P < 0.05),但在第三年降至 45%。热汇报表现和代码记录流程方法并未被广泛采用,但正式的代码团队审查在80%的事件中被迅速记录下来:结论:有效的心肺复苏团队响应具有一些固有的共同特征。我们医院正在通过重组委员会、简化任务、购置新技术和加强反馈回路等措施,确保在每次儿科 IHCA 事件中都能以最佳方式执行这些常见任务和技术。早期结果分析表明,小儿心肺复苏术后的出院存活率有了初步改善。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Establishing a Quality Improvement Program for Pediatric In-hospital Cardiac Arrest.

Background: Pediatric In-hospital Cardiac Arrest (IHCA) is a rare event with a 50-55% mortality rate. Techniques of Cardiopulmonary Resuscitation (CPR), medication and electrical therapy timing, team dynamics, simulation and debriefing programs are associated with improved outcomes. This study aimed to improve outcomes after IHCA by describing and implementing quality improvement processes that cross and coordinate among traditional siloed pediatric resuscitation team structures.

Methods: We chose three outcome measures: (1) return of spontaneous circulation (ROSC), (2) 24-hour survival after IHCA, and (3) survival to hospital discharge. Process outcomes include (1) hot debriefs performed with a standardized form, (2) code documentation using a revised form, and (3) formal code team review presented to a central Emergency Management Committee, using a standardized form.

Results: One hundred and thirty-two patients experienced 176 events during the 36-month study period. Survival to hospital discharge increased from 33% during year 1 to 60% during year 2 (P < 0.05) but decreased to 45% in year 3. Both hot debrief performance and code documentation process methods did not demonstrate widespread adoption, but formal code team review was documented in 80% of events quite rapidly.

Conclusions: There are common traits inherent to effective CPR team response. Ensuring optimal performance of these common tasks and techniques in every pediatric IHCA event in our hospital is being addressed by committee reorganization, task simplification, new technology acquisition and enhanced feedback loops. Early outcome analysis shows initial improvement in survival to hospital discharge after pediatric IHCA.

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CiteScore
2.20
自引率
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