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首页> 外文期刊>British journal of neurosurgery >Chronic subdural haematomas: a single-centre experience developing an integrated care pathway
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Chronic subdural haematomas: a single-centre experience developing an integrated care pathway

机译：慢性硬质血肿：开发综合护理途径的单中心经验

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Objective: To improve quality of care for patients presenting with chronic subdural haematoma (CSDH) by introducing a multi-disciplinary integrated care pathway.Summary background: CSDH is a common neurological condition. Incidence rises with age and currently affects around 58/100 000 people over 70 years. Six-month mortality is high (26%), however integrated care pathways have been shown to improve patient outcomes in other surgical subspecialties.Materials and methods: A baseline retrospective audit completed in 2012 identified areas for improvement in patient management. Stakeholder meetings were held with subsequent development and implementation of a patient care pathway. A post-implementation prospective audit was completed between January and October 2015. Data collected: patient demographics, medical co-morbidities, use of anti-platelet and anti-coagulant medication, timing of surgery, length of hospital stay, morbidity and mortality data, and reaccumulation rate.Results: Patient groups were similar with a high incidence of multi-morbidity. The key areas targeted for improvement included enhanced pre-operative optimisation and time to surgery. Implementation of the patient care pathway significantly increased the number of patients undergoing surgery within 24hours of admission (43% vs. 75%, p=0.0006) but length of hospital stay did not change. Operative morbidity and mortality remained similar and there was no significant difference in CSDH reaccumulation rate.Conclusion: Our patient care pathway appears to have improved pre-operative care and significantly increased the proportion of patients undergoing surgery within 24hours of admission. Difficulties were encountered with changing existing practice. Prospective research is required to demonstrate the full benefits, which may include a reduction in health and social care costs.
机译：目的：通过引入多学科综合护理途径，提高患有慢性软骨血肿（CSDH）的患者的护理质量。样品背景：CSDH是一种常见的神经功能。发生率随着年龄的增长，目前影响了70多年的58/1万人。六个月的死亡率高（26％），但已显示综合护理途径，以改善其他外科亚特色的患者结果。材料和方法：2012年完成的基线回顾审计确定了患者管理的改善领域。利益攸关方会议随后的开发和实施患者护理途径。在2015年1月至10月之间完成后的前瞻性审计。收集数据：患者人口统计，医疗合作，使用抗血小板和抗凝血药物，手术时序，住院时间长度，发病率和死亡率数据，和Reaccumulation率。结果：患者群体与多发病率的高发病率相似。针对改进的关键区域包括增强的术前优化和手术时间。患者护理途径的实施显着增加了24小时内接受手术的患者的数量（43％与75％，P = 0.0006），但医院住院的长度没有变化。手术发病率和死亡率仍然相似，CSDH Reacrumulation率没有显着差异。结论：我们的患者护理途径似乎有改善的术前护理，并且显着增加了24小时内接受手术的比例。改变现有惯例遇到困难。需要展示潜在的研究来证明全部福利，这可能包括减少健康和社会护理费用。

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