超级通道有多超级?通过儿科急诊室加快对快速通道患者的护理。

IF 1.2 Q3 PEDIATRICS
Pediatric quality & safety Pub Date : 2024-09-18 eCollection Date: 2024-09-01 DOI:10.1097/pq9.0000000000000770
Daniel Lam, Cortney Braund, Sarah Schmidt, Bernadette Johnson, Sandra P Spencer, Chisom Agbim
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引用次数: 0

摘要

背景:快速通道模式通过将低危重病人转入快速护理通道,减少了急诊科(ED)的病人拥挤情况。2016 年,该机构的儿科急诊室为在快速评估分诊区接受评估但需要在主急诊室接受进一步治疗的患者设立了快速通道。这一 "超级通道 "旨在为需要最多 1 小时额外护理的患者提供服务,但缺乏确保这些患者在预期时间内出院的方法:我们的目标是将在分配到急诊室病床后 1 小时内出院的 "超级通道 "患者比例从 17% 提高到 50%。干预措施包括制定客观的超级追踪标准、全科室范围内的进度报告、个性化提醒、入院会诊和文档提示。我们利用统计流程控制图将计划、执行、研究、行动(PDSA)周期的数据可视化,以确定特殊原因造成的差异:结果:Supertrack 患者在预期时间内出院的比例从 17% 提高到 27%,而急诊室复诊率并未增加。Supertrack 患者在急诊室的平均停留时间从 121 分钟减少到 103 分钟。个性化提醒的效果显著,但持续时间较短:我们改善了超级追踪患者的就医流程,缩短了他们的住院时间,增加了在预期时间内出院的人数。不足之处包括呼吸道主诉患者人数意外激增,以及由于人员和结构的限制,无法指定一个独立的超级追踪评估空间并配备专门的服务提供者。这些研究结果有助于医疗机构在有限的空间和资源条件下开发有效的快速通道模式。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How Super Is Supertrack? Expediting Care of Fast-track Patients through a Pediatric Emergency Department.

Background: Fast-track models decrease patient crowding in emergency departments (EDs) by redirecting low-acuity patients to an expedited care pathway. In 2016, this institution's pediatric ED created a fast-track pathway for patients evaluated in a rapid assessment triage area who needed further management in the primary ED. This "Supertrack" designation was intended for patients requiring up to 1 hour of additional care, though means of ensuring these patients were discharged within their anticipated timeframe were lacking.

Methods: We aimed to increase the percentage of Supertrack patients discharged within 1 hour of their ED bed assignment from 17% to 50%. Interventions included the creation of objective Supertrack criteria, departmental-wide progress reports, personalized reminders, intake huddles, and documentation prompts. We visualized data from Plan, Do, Study, Act (PDSA) cycles with statistical process control charts to determine special cause variation.

Results: The percentage of Supertrack patients discharged within their anticipated timeframe increased from 17% to 27% without an increase in return ED visits. The average time Supertrack patients spent in the ED decreased from 121 to 103 minutes. Personalized reminders demonstrated a significant but short-lived improvement.

Conclusions: We improved the flow of Supertrack patients by decreasing their length of stay and increasing how many were discharged within their anticipated timeframe. Limitations included an unexpected surge in patients with respiratory complaints and staffing and structural constraints preventing the designation of a discrete Supertrack assessment space with dedicated providers. These findings are helpful for institutions seeking to develop an effective fast-track model with limited space and resources.

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来源期刊
CiteScore
2.20
自引率
0.00%
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