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首页> 外文期刊>Patient Safety in Surgery >“The National Surgery Quality Improvement Project” (NSQIP): a new tool to increase patient safety and cost efficiency in a surgical intensive care unit
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“The National Surgery Quality Improvement Project” (NSQIP): a new tool to increase patient safety and cost efficiency in a surgical intensive care unit

机译：“国家外科手术质量改善项目”（NSQIP）：在外科重症监护室提高患者安全性和成本效率的新工具

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Background The “National Surgical Quality Improvement Program” (NSQIP) is a nationally validated, risk-adjusted database tracking surgical outcomes. NSQIP has been demonstrated to decrease complications, expenses, and mortality. In the study institution, a high rate of nosocomial pneumonia (PNEU) and prolonged ventilator days ≥48?hours (V48) was observed on the surgical service. Methods The hospital studied is a 500 bed university-affiliated teaching hospital performing approximately 20,000 surgical operations per year. A multidisciplinary team was formed and a series of interventions were implemented to address high pneumonia rates and prolonged intubation. Specific interventions included enforcement of protocols and adherence to the Institute for Healthcare Improvement (IHI) ventilator bundles, including head of bed elevation, sedation holidays, extubate when ready, and early nutrition. NSQIP collected pre-operative through 30-day postoperative data prospectively on 1,081 surgical patients in the intensive care unit from January 1, 2010 – July 31, 2012. The variables pneumonia and V48 undergo logistic regression and risk adjusted results of observed versus expected are calculated. Mean and confidence intervals are represented in caterpillar charts and bar graphs. Statistical analysis was via Fisher exact t-test. Results Progressive improvements were observed over a two-year period via three semiannual reports (SAR). Corrective measures showed a decrease in V48 with an observed to expected odds ratio (O: E) improving from 1.5 to 1.04, or 1.9% ( 7/368 patients) July 31, 2011 to 1.11% (12/1080 patients) July 31, 2012 respectively. Similarly, pneumonia rates decreased 1.36% (5/368 patients) July 31, 2011 to 1.2% ( 13/1081 patients) July 31, 2012 with O: E?=?1.4 and 1.25 respectively. Statistical significance was achieved (p? Conclusion Given an estimated annual volume of 20,000 cases per year with a cost of $22,097 per episode of pneumonia and $27,654 per episode of prolonged intubation greater than 48?hours; a projected 32 avoided episodes of pneumonia and 160 avoided episodes of V48 could be realized with potential savings exceeding $5,000,000.
机译：背景技术“国家手术质量改善计划”（NSQIP）是一项经过国家验证，经过风险调整的数据库，可跟踪手术结果。 NSQIP已被证明可以减少并发症，费用和死亡率。在该研究机构中，在手术过程中观察到较高的医院内肺炎（PNEU）发生率和延长的呼吸机天数≥48？小时（V48）。方法研究的医院是一家有500张床的大学附属教学医院，每年约进行20,000次外科手术。成立了一个多学科小组，并实施了一系列干预措施，以解决肺炎高发和长期插管的问题。具体的干预措施包括执行方案并遵守医疗保健改善研究所（IHI）的呼吸机束，包括抬高床头，镇静假期，准备时拔管和早期营养。从2010年1月1日至2012年7月31日，NSQIP对重症监护病房的1,081例外科手术患者进行了术前至术后30天的数据收集。对肺炎和V48变量进行了logistic回归分析，并计算了观察值与预期值的风险调整结果。 。平均值和置信区间以毛虫图和条形图表示。统计分析通过Fisher精确t检验进行。结果通过三个半年度报告（SAR）在两年内观察到了逐步改善。纠正措施显示，V48降低，观察到的预期比值比（O：E）从1.5改善至1.04，即1.9％（7/368位患者），从2011年7月31日提高到1.11％（12/1080位患者），7月31日， 2012年。同样，2012年7月31日的肺炎发生率降低了1.36％（5/368例患者），降至2012年7月31日的1.2％（13/1081例患者），O：E E =？1.4和1.25。结论具有统计学意义（p？结论）鉴于每年估计有20,000例病例，每发作一次肺炎的费用为22,097美元，长时间插管超过48小时需支付27,654美元;预计避免32例肺炎发作和160例避免肺炎发作V48的每一集都可以实现，并可能节省超过$ 5,000,000。

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