Translating CER results from ICU study to improve outcomes in cardiac surgery

将 ICU 研究的 CER 结果转化为改善心脏手术的结果

• 批准号: 8146868
• 负责人: Peter J. Pronovost
• 金额: $ 142.95万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8146868
• 关键词: Translating; CER; results; ICU; study

DESCRIPTION (provided by applicant): The overall goal of this program is to substantially reduce the mortality, morbidity, and costs of care in patients having cardiac surgery by implementing an interdisciplinary and multifaceted patient safety program, demonstrated in CER to improve patient outcomes, in a cohort of hospitals. We will build upon our prior efforts to improve patient safety throughout the state of Michigan. We plan to use the same unit-based model to reduce morbidity and mortality in cardiac surgery by linking unit-based teams from the operating room (OR), intensive care unit (ICU), and floor within a hospital. We partnered with the Society for Cardiovascular Anesthesia Foundation (SCAF) and the Society for Thoracic Surgeons (STS) to conduct and spread this research. The STS has a mature database into which most hospitals performing cardiac surgery in the U.S. report data. Their approach to improvement is to send performance reports to hospital without offering improvement interventions (termed passive feedback) and benchmark data to teams. This approach contrasts with our Michigan project, in which teams actively implemented an interdisciplinary and multifaceted patient safety program and received feedback regarding performance. We hypothesize that the combination of feedback of performance data, as STS has done, with a multifaceted intervention demonstrated in CER to reduce infectious complications and a program to improve culture in cardiac surgery, will result in a greater reduction in 30-day mortality, length of stay, and readmissions than passive feedback alone. The specific aims of this proposal including the following; 1. To implement and evaluate the impact of a patient safety program on rates of surgical site infections and OR safety culture in a cohort of cardiac ORs. 2. To implement and evaluate the impact of a patient safety program on rates of central line-associated bloodstream infections, ventilator-associated pneumonia, and safety culture in cardiac surgical ICUs. 3. To implement and evaluate the impact of a patient safety program on errors associated with handoffs from the ICU to the floor and discharge from the hospital, and with safety culture in a cohort of hospital floors that care for cardiac surgical patients. 4. To evaluate the combined impact of a patient safety program in cardiac ORs, ICUs, and floors compared to passive feedback of outcome data on 30-day mortality, hospital readmissions, and hospital length of stay, in a cohort of hospitals providing cardiac surgery. This study has the potential to substantially reduce mortality, length of stay, and readmissions in cardiac surgery and to develop new knowledge regarding how to improve patient safety. PUBLIC HEALTH RELEVANCE: The overall goal of this program is to substantially reduce the mortality, morbidity, and costs of care in patients having cardiac surgery by comparing the impact of passive reporting of performance data to an interdisciplinary and multifaceted patient safety program in a cohort of hospitals. We partnered with the STS and SCAF to implement and evaluate the impact of a safety program on 30 day mortality, readmission and LOS in patients having cardiac surgery. This study has the potential to substantially reduce mortality, length of stay, and readmissions in cardiac surgery and to develop new knowledge regarding how to improve patient safety.

描述（由申请人提供）：该计划的总体目标是通过实施跨学科和多方面的患者安全计划，大大降低接受心脏手术的患者的死亡率，发病率和护理成本，在CER中证明，以改善医院的患者结果。我们将基于先前的努力，以改善整个密歇根州的患者安全。我们计划使用相同的基于单位的模型来降低心脏手术中的发病率和死亡率，通过将手术室，重症监护室（ICU）（ICU）和医院内的基于单位的团队联系起来。我们与心血管麻醉基金会（SCAF）和胸外科医师协会（STS）合作，进行和传播这项研究。 STS有一个成熟的数据库，大多数医院在美国报告数据中进行心脏手术。他们的改进方法是将绩效报告发送给医院，而无需提供改进干预措施（被称为被动反馈）和基准数据向团队进行基准数据。这种方法与我们的密歇根州项目形成鲜明对比，在该项目中，团队积极实施了跨学科和多方面的患者安全计划，并收到了有关绩效的反馈。我们假设，像STS一样，在CER中表现出的多方面干预措施的绩效数据反馈的结合，可减少感染性并发症和改善心脏手术文化的计划，将导致30天的死亡率，住院时间和复兴性的降低，而不是单独使用。该提案的具体目的包括以下； 1。在心脏ORS队列中实施和评估患者安全计划对手术部位感染和 / / /或安全培养的影响。 2。实施和评估患者安全计划对中央线相关血液感染，呼吸机相关性肺炎和安全培养的影响。 3。实施和评估患者安全计划对与医院和从医院出院的交接相关的错误以及在医院楼层中的安全文化相关的错误的影响。 4。为了评估患者安全计划在心脏ORS，ICU和地板中的综合影响，与关于30天死亡率，医院再入院和住院时间的被动反馈相比，在提供心脏手术的一系列医院中。这项研究有可能大大降低死亡率，住院时间和心脏手术的再入院，并开发有关如何改善患者安全的新知识。 公共卫生相关性：该计划的总体目标是通过将被动报告对绩效数据的被动报告与跨学科和多方面的患者安全计划的影响大大降低心脏手术患者的死亡率，发病率和费用。我们与STS和SCAF合作，实施和评估安全计划对30天死亡率，再入院和LOS对心脏手术的患者的影响。这项研究有可能大大降低死亡率，住院时间和心脏手术的再入院，并开发有关如何改善患者安全的新知识。