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首页> 美国卫生研究院文献>Annals of the American Thoracic Society >An Innovative Framework to Improve Efficiency of Interhospital Transfer of Children in Respiratory Failure
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An Innovative Framework to Improve Efficiency of Interhospital Transfer of Children in Respiratory Failure

机译：一个创新的框架以提高儿童在呼吸衰竭中医院间转移的效率

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>Rationale: High mortality and resource use burden are associated with hospitalization of critically ill children transferred from level II pediatric intensive care units (PICUs) to level I PICUs for escalated care. Guidelines urge transfer of the most severely ill children to level I PICUs without specification of either the criteria or the best timing of transfer to achieve good outcomes.>Objectives: To identify factors associated with transfer, develop a modeling framework that uses those factors to determine thresholds to guide transfer decisions, and test these thresholds against actual patient transfer data to determine if delay in transfer could be reduced.>Methods: A multistep approach was adopted, with initial identification of factors associated with transfer status using data from a prior case–control study conducted with children with respiratory failure admitted to six level II PICUs between January 1, 1997, and December 31, 2007. To identify when to transfer a patient, thresholds for transfer were created using generalized estimating equations and discrete event simulation. The transfer policies were then tested against actual transfer data.>Measurements and Main Results: Multivariate logistic regression revealed that the absolute difference of a patient’s pediatric logistic organ dysfunction score from the admission value, high-frequency oscillatory ventilation use, antibiotic use, and blood transfusions were all significantly associated with transfer status. The resulting threshold policies led to average transfer delay reduction ranging from 0.5 to 2.3 days in the testing dataset.>Conclusions: Current transfer guidelines are devoid of criteria to identify critically ill children who might benefit from transfer and when the best time to transfer might be. In this study, we used innovative methods to create thresholds of transfer that might reduce delay in transfer.
机译：>理论依据：高死亡率和资源使用负担与重症儿童住院有关，这些重症儿童从二级儿科重症监护病房（PICU）转移到一级PICU以进行逐步护理。准则敦促将重病重的儿童转移到I级重症监护病房，而没有规定转移的标准或最佳时机，以取得良好的结果。>目标：要确定与转移相关的因素，请建立模型框架使用这些因素确定阈值以指导转移决策，并针对实际患者转移数据测试这些阈值以确定是否可以减少转移延迟。>方法：采用了多步方法，初步确定了使用先前病例对照研究的数据对与转移状态相关的因素进行了研究，这些数据是在1997年1月1日至2007年12月31日之间接受六个II级PICU的呼吸衰竭患儿进行的。为确定何时转移患者，转移阈值为使用广义估计方程和离散事件模拟创建。然后针对实际的转移数据测试转移策略。>测量和主要结果：多元logistic回归显示，患者的小儿逻辑器官功能障碍评分与入院值，高频振荡通气使用的绝对差异，抗生素使用和输血均与转移状态显着相关。结果阈值策略导致测试数据集中的平均转移延迟减少0.5到2.3天。>结论：当前的转移指南缺乏确定可能从转移中受益的重症儿童以及何时转移的危重儿童的标准。最好的转移时间是。在这项研究中，我们使用了创新的方法来创建转移阈值，以减少转移的延迟。

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