儿科急诊准备改进协作干预对患者住院结果的影响。

IF 3 3区医学 Q1 PEDIATRICS

Academic Pediatrics Pub Date : 2024-11-01 DOI:10.1016/j.acap.2024.04.006

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引用次数: 0

摘要

目的我们假设，为提高加权儿科准备评分（WPRS）而采取的合作干预措施将有助于降低儿科重症监护室（PICU）死亡率、缩短儿科重症监护室和医院的住院时间。方法本研究分析了从普通急诊科（GED）转入本院的急诊伤病员。干预措施包括定制评估报告，重点关注团队绩效和儿科准备系统的改进、共享最佳实践和临床资源、在每个普通急诊科指定一名儿科急诊护理协调员护士（PECC），并在 2 个月和 4 个月时持续进行互动。我们从干预前后的病历中收集了数据，重点关注从 GED 转到儿科急诊部 (ED) 或直接入住 PICU 的患者。对临床结果进行了评估，如 PICU 的住院时间 (LOS)、住院时间和 PICU 死亡率。人口统计学采用描述性统计，数据分析采用各种统计检验。结果干预前有 278 名患者，干预后有 314 名患者。多变量分析显示，WPRS 的变化与 PICU LOS 的减少（β = -0.05 [95% CI: -0.09, -0.01]，P = .02）和住院 LOS 的减少（β = -0.12 [95% CI: -0.21, -0.04]，P = .04）之间存在显著关联，但干预措施与其他患者预后之间没有关联。今后应重点推广儿科准备工作，以改善全国重症儿童的预后。

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The Effect of a Collaborative Pediatric Emergency Readiness Improvement Intervention on Patients’ Hospital Outcomes

Objective

We hypothesized that collaborative intervention to improve weighted pediatric readiness score (WPRS) will be associated with decreased pediatric intensive care (PICU) mortality, PICU and hospital length of stay.

Methods

This study analyzes the transfer of acutely ill and injured patients from general emergency departments (GEDs) to our institution. The intervention involved customized assessment reports focusing on team performance and systems improvement for pediatric readiness, sharing best practices and clinical resources, designation of a nurse pediatric emergency care coordinator (PECC) at each GED and ongoing interactions at 2 and 4 months. Data was collected from charts before and after the intervention, focusing on patients transferred to our pediatric emergency department (ED) or directly admitted to our PICU from the GEDs. Clinical outcomes such as PICU length of stay (LOS), hospital LOS, and PICU mortality were assessed. Descriptive statistics were used for demographics, and various statistical tests were employed to analyze the data. Bivariate analyses and multivariable models were utilized to examine patient outcomes and the association between the intervention and outcomes.

Results

There were 278 patients in the pre-intervention period and 314 patients in the post-intervention period. Multivariable analyses revealed a significant association between the change in WPRS and decreased PICU LOS (β = −0.05 [95% CI: −0.09, −0.01), P = .02), and hospital LOS (β = −0.12 [95% CI: −0.21, −0.04], P = .04), but showed no association between the intervention and other patient outcomes.

Conclusions

In this cohort, improving pediatric readiness scores in GEDs was associated with significant improvements in PICU and hospital length of stay. Future initiatives should focus on disseminating pediatric readiness efforts to improve outcomes of critically ill children nationally.

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来源期刊

Academic Pediatrics PEDIATRICS-

CiteScore

4.60

自引率

12.90%

发文量

300

审稿时长

60 days

期刊介绍： Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.