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首页> 外文期刊>Topics in stroke rehabilitation >Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model.
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Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model.

机译：重症监护病房设置中的康复质量改善：质量改善模型的实施。

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Objective: There are barriers to providing early physical medicine and rehabilitation (PM&R) in the intensive care unit (ICU). We present a specific model for undertaking quality improvement (QI) projects and a case study focused on QI for early PM&R in the ICU. Methods: The QI project was undertaken using a 4-step model: (1) summarizing the evidence, (2) identifying barriers, (3) establishing performance measures, and (4) ensuring patients receive the intervention. To evaluate the application and outcomes of this model, we present data collected during a 4-month QI period versus an immediately preceding 3-month control period. Results: Deep sedation was a major barrier to early PM&R that was addressed in the QI project. Compared to the control period, there was a decrease in medical ICU (MICU) days with any benzodiazepine use (73% vs 96% of days, P = .03) and narcotic use (77% vs 96%, P = .05) and improved delirium status (MICU days without delirium, 53% vs 21%, P = .003). In addition, more QI patients had physical therapy consultations (93% vs 59%, P = .004) and greater number of rehabilitation treatments with higher functional mobility (treatments involving sitting or greater mobility, 78% vs 56%, P = .03). Hospital data for the QI period demonstrated a decrease in average length of stay in the MICU (4.9 vs 7.0 days, P = .02) and hospital (14.1 vs 17.2, P = .03) compared to the prior year. Conclusion: A structured QI model can be applied to implementation of early PM&R in the ICU resulting in markedly improved delirium status, delivery of PM&R, functional mobility, and length of stay.
机译：目的：在重症监护病房（ICU）中提供早期物理医学和康复（PM＆R）存在障碍。我们提供了一个进行质量改进（QI）项目的特定模型，以及针对ICU中早期PM＆R的QI的案例研究。方法：QI项目使用4个步骤的模型进行：（1）总结证据;（2）识别障碍;（3）建立绩效指标;以及（4）确保患者接受干预。为了评估该模型的应用和结果，我们介绍了在4个月的QI期间相对于之前3个月的对照期间收集的数据。结果：QI计划解决了深度镇静是早期PM＆R的主要障碍。与对照组相比，使用苯二氮卓类药物的医疗ICU（MICU）天数减少（73％vs 96％，P = .03）和麻醉剂使用（77％vs 96％，P = .05）并改善del妄状态（无days妄的MICU天数，分别为53％和21％，P = .003）。此外，更多的QI患者接受了物理治疗咨询（93％vs 59％，P = .004），并且功能性活动能力更高的康复治疗的数量更多（涉及坐位或更大运动能力的治疗，78％vs 56％，P = .03） ）。 QI期的医院数据显示，与去年相比，MICU的平均住院时间（4.9天和7.0天，P = .02）和医院的住院时间（14.1 vs 17.2，P = .03）有所减少。结论：结构化的QI模型可应用于ICU中早期PM＆R的实施，从而显着改善del妄状态，PM＆R的递送，功能性活动性和住院时间。

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