Victoria Ando, Alexia Cavin-Trombert, David Gachoud, Matteo Monti
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引用次数: 0
摘要
背景：查房是医院环境中必不可少的活动。尽管他们在指导病人护理方面发挥着重要作用，但他们没有标准化的方法。在查房期间实施结构化干预措施可改善诸如效率、文件和沟通等结果。这些改善是否对临床结果有影响尚不清楚。我们的系统综述评估了引导查房的结构化干预措施是否会影响患者的预后。方法：于2023年5月在Embase、Medline、CINAHL、ERIC、Web of Science Core Collection、Cochrane Library （Wiley）和谷歌Scholar上进行系统检索，并于2024年1月进行前后引文检索。我们纳入了同行评审的原始研究，评估了床边查房（BWRs）期间结构化干预措施对临床结果的影响。包括所有进行bwr的住院医院环境。我们排除了关于董事会、教学或药物查房的论文。结果：我们的搜索策略产生了29项研究。2项为随机对照试验（rct）， 27项为准实验干预性研究。大多数（79%）是在重症监护病房进行的。报告的主要临床结果为死亡率、感染并发症、住院时间（LOS）和机械通气时间（DoMV）。构建BWRs的干预措施似乎没有对死亡率、LOS以及尿路和中央静脉相关血流感染率产生积极或消极的影响，而有关其对呼吸机相关肺炎和DoMV发生率的影响的证据是相互矛盾的，有迹象表明结果有所改善。研究通常是低到中等质量的。结论：bws期间的结构化干预对临床结果的影响尚不明确。需要更高质量的研究，重点放在多中心随机对照试验或前瞻性前后试验，同时进行队列，匹配关键特征。普洛斯彼罗注册号：CRD42023412637。
Does the use of structured interventions to guide ward rounds affect patient outcomes? A systematic review.
Background: Ward rounds are an essential activity occurring in hospital settings. Despite their fundamental role in guiding patient care, they have no standardised approach. Implementation of structured interventions during ward rounds was shown to improve outcomes such as efficiency, documentation and communication. Whether these improvements have an impact on clinical outcomes is unclear. Our systematic review assessed whether structured interventions to guide ward rounds affect patient outcomes.
Methods: A systematic search was carried out in May 2023 on Embase, Medline, CINAHL, ERIC, Web of Science Core Collection, the Cochrane Library (Wiley) and Google Scholar, and a backward and forward citation search in January 2024. We included peer-reviewed, original studies assessing the use of structured interventions during bedside ward rounds (BWRs) on clinical outcomes. All inpatient hospital settings where BWRs are performed were included. We excluded papers looking at board, teaching or medication rounds.
Results: Our search strategy yielded 29 studies. Two were randomised controlled trials (RCTs) and 27 were quasi-experimental interventional studies. The majority (79%) were conducted in intensive care units. The main clinical outcomes reported were mortality, infectious complications, length of stay (LOS) and duration of mechanical ventilation (DoMV). Mortality, LOS and rates of urinary tract and central-line associated bloodstream infections did not seem to be affected, positively or negatively, by interventions structuring BWRs, while evidence was conflicting regarding their effects on rates of ventilator-associated pneumonia and DoMV, with a signal towards improved outcomes. Studies were generally of low-to-moderate quality.
Conclusion: The impact of structured interventions during BWRs on clinical outcomes remains inconclusive. Higher quality research focusing on multicentric RCTs or on prospective pre-post trials with concurrent cohorts, matched for key characteristics, is needed.
期刊介绍：
BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement.
The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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