• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文学位 >The Relationship between Quality of Care in the Emergency Department and Timeliness of Interventions for Patients with Severe Sepsis
【24h】

The Relationship between Quality of Care in the Emergency Department and Timeliness of Interventions for Patients with Severe Sepsis

机译：严重脓毒症患者急诊服务质量与干预及时性的关系

获取原文
获取原文并翻译 | 示例
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

A comprehensive review of relevant literature was conducted using CINHAL, Medline, and Proquest to include the following search words: ED crowding, ED LOS, ED boarding, critical care, timeliness of care, early goal-directed therapy, sepsis bundle, mortality, nursing experience, expertise and competency. Emergency Department (ED) crowding and a delay in transferring critically-ill patients out of the department may adversely influence the delivery of timely treatment and adherence to established sepsis protocols. In addition, crowding can increase ED LOS and may increase HLOS and/or mortality for severe sepsis patients. In a landmark study by Rivers et al. (2001), a significant decrease in mortality was observed in patients with severe sepsis who were treated with early goal-directed therapy in the ED. Donabedian's structure, process, and outcome (SPO) model was utilized as a framework to evaluate the quality of care in the ED. A retrospective, exploratory research design was used with a non-probability, purposive sample of critically-ill patients seen in the ED and admitted to the intensive care unit.;In general, the effect of the predictor variables on the timeliness of care and sepsis bundle compliance was found to be small. ED volume had very little influence on the outcome variables when using sepsis bundle interventions as a surrogate for quality of care. ED volume had minimal influence (3-5%) on timeliness of lactate draw, collection of blood cultures, and administration of antibiotics. Overall, sepsis bundle compliance was not directly influenced by ED volume. Instead, the importance of hospital characteristics, positive sepsis screens, and hypotension were identified as key factors influencing compliance. A delay in the identification of severe sepsis can be an important factor in determining compliance and timeliness of bundle interventions. In this study, a positive sepsis screen increased the odds of obtaining a serum lactate level by 76% and antibiotic administration within three hours by 72%. ED LOS only explained 1% of the variance in hospital length of stay (HLOS) and did not increase the occurrence of mortality prior to hospital discharge. In conclusion, ED volume by itself is not as significant of an influence in this health system as other factors. The goal of this study was to explore the effects of ED volume and other predictors variables on the quality of care delivered to severe sepsis patients. While the quality of care is impacted by several organizational and process factors it was not directly influenced by ED volume. Therefore, improvement efforts should focus on the removal of organizational barriers, building a more effective screening process and developing the role of the ED nurse in the management of sepsis patients.
机译：使用CINHAL，Medline和Proquest对相关文献进行了全面回顾，包括以下搜索词：ED拥挤，ED LOS，ED登机，重症监护，护理及时性，早期目标导向治疗，败血症捆绑，死亡率，护理经验，专业知识和能力。急诊科（ED）拥挤，以及重症患者转出急诊科的延迟可能会对及时提供治疗和遵守既定的败血症方案产生不利影响。另外，对于严重的败血症患者，拥挤会增加ED LOS并可能增加HLOS和/或死亡率。在Rivers等人的里程碑式研究中。 （2001），观察到严重脓毒症患者在ED中接受早期目标导向治疗的死亡率显着降低。 Donabedian的结构，过程和结果（SPO）模型被用作评估急诊室护理质量的框架。使用回顾性探索性研究设计，对急诊室中发现的重症患者的非概率性目的样本进行了研究，并被送往重症监护室;一般而言，预测变量对护理和败血症及时性的影响发现捆绑的合规性很小。当使用败血症束干预作为护理质量的替代指标时，ED量对结果变量几乎没有影响。 ED量对乳汁的及时性，血液培养物的收集和抗生素的使用的影响最小（3-5％）。总体而言，败血症束的依从性不受ED量的直接影响。相反，医院特征，败血症筛查阳性和低血压的重要性被确定为影响依从性的关键因素。严重脓毒症的识别延迟可能是确定捆绑治疗的依从性和及时性的重要因素。在这项研究中，脓毒症筛查呈阳性的几率使获得血清乳酸水平的几率提高了76％，在三小时内施用抗生素的几率提高了72％。 ED LOS仅解释了住院时间（HLOS）差异的1％，并没有增加出院前死亡率的发生率。总之，ED量本身对健康体系的影响不如其他因素重要。这项研究的目的是探讨ED量和其他预测变量对重症脓毒症患者护理质量的影响。虽然护理质量受多个组织和过程因素的影响，但并不受ED量的直接影响。因此，改善工作应着眼于消除组织障碍，建立更有效的筛查程序并发展急诊室护士在败血症患者管理中的作用。

著录项

  • 作者

    Dugan, Elizabeth T.;

  • 作者单位

    George Mason University.;

  • 授予单位 George Mason University.;
  • 学科 Nursing.
  • 学位 Ph.D.
  • 年度 2011
  • 页码 210 p.
  • 总页数 210
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号