PDF(Pubmed)
Abstract：
Evidence-based clinical care guidelines improve medical treatment by reducing error, improving outcomes and possibly lowering healthcare costs. While some data exist on individual guideline compliance, no data exist on overall compliance to multiple nuanced guidelines in a paediatric intensive care setting.
Guideline compliance was observed and measured with a prospective cohort at a tertiary academic paediatric medical-surgical intensive care unit. Adherence to 19 evidence-based clinical care guidelines was evaluated in 814 patients, and reasons for non-compliance were noted along with other associated outcomes.
Overall facility compliance was unexpectedly high at 77.8% over 4512 compliance events, involving 826 admissions. Compliance varied widely between guidelines. Guidelines with the highest compliance were stress ulcer prophylaxis (97.1%) and transfusion administration such as fresh frozen plasma (97.4%) and platelets (94.8%); guidelines with the lowest compliance were ventilator-associated pneumonia prevention (28.7%) and vitamin K administration (34.8%). There was no significant change in compliance over time with observation. Guidelines with binary decision branch points or single-page decision flow diagrams had a higher average compliance of 90.6%. Poor compliance was more often observed with poor perception of guideline trustworthiness and time limitations.
Measuring guideline compliance, though onerous, allowed for evaluation of current clinical practices and identified actionable areas for institutional improvement.
Guideline compliance was observed and measured with a prospective cohort at a tertiary academic paediatric medical-surgical intensive care unit. Adherence to 19 evidence-based clinical care guidelines was evaluated in 814 patients, and reasons for non-compliance were noted along with other associated outcomes.
Overall facility compliance was unexpectedly high at 77.8% over 4512 compliance events, involving 826 admissions. Compliance varied widely between guidelines. Guidelines with the highest compliance were stress ulcer prophylaxis (97.1%) and transfusion administration such as fresh frozen plasma (97.4%) and platelets (94.8%); guidelines with the lowest compliance were ventilator-associated pneumonia prevention (28.7%) and vitamin K administration (34.8%). There was no significant change in compliance over time with observation. Guidelines with binary decision branch points or single-page decision flow diagrams had a higher average compliance of 90.6%. Poor compliance was more often observed with poor perception of guideline trustworthiness and time limitations.
Measuring guideline compliance, though onerous, allowed for evaluation of current clinical practices and identified actionable areas for institutional improvement.
摘要：
背景：循证临床护理指南通过减少错误来改善医学治疗，改善结果，并可能降低医疗成本。虽然存在一些关于个人指南合规性的数据，在儿科重症监护机构中,没有关于总体遵守多项细微差别指南的数据.
方法：在第三级学术儿科内科-外科重症监护病房，通过前瞻性队列观察和测量指南依从性。对814例患者的19个循证临床护理指南的依从性进行了评估。并指出了不合规的原因以及其他相关结果。
结果：在4512次合规事件中，总体设施合规率出乎意料地高达77.8%，涉及826个招生。准则之间的合规性差异很大。依从性最高的指南是预防应激性溃疡(97.1%)和输注新鲜冰冻血浆(97.4%)和血小板(94.8%);依从性最低的指南是预防呼吸机相关性肺炎(28.7%)和维生素K(34.8%)。随着时间的推移，观察的依从性没有显著变化。具有二元决策分支点或单页决策流程图的指南的平均合规性较高，为90.6％。更常观察到依从性差，对指南可信性和时间限制的认识差。
结论：衡量指南合规性，虽然繁重，允许评估当前的临床实践，并确定可用于机构改进的可行领域。
方法：在第三级学术儿科内科-外科重症监护病房，通过前瞻性队列观察和测量指南依从性。对814例患者的19个循证临床护理指南的依从性进行了评估。并指出了不合规的原因以及其他相关结果。
结果：在4512次合规事件中，总体设施合规率出乎意料地高达77.8%，涉及826个招生。准则之间的合规性差异很大。依从性最高的指南是预防应激性溃疡(97.1%)和输注新鲜冰冻血浆(97.4%)和血小板(94.8%);依从性最低的指南是预防呼吸机相关性肺炎(28.7%)和维生素K(34.8%)。随着时间的推移，观察的依从性没有显著变化。具有二元决策分支点或单页决策流程图的指南的平均合规性较高，为90.6％。更常观察到依从性差，对指南可信性和时间限制的认识差。
结论：衡量指南合规性，虽然繁重，允许评估当前的临床实践，并确定可用于机构改进的可行领域。
