目的:系统地定位,评估和综合有关跨专业气管造口术团队在增加说话瓣膜使用和减少说话和拔管时间方面的有效性的证据,不良事件,住院时间(重症监护病房(ICU)和住院)和死亡率。此外,评估在医院环境中实施跨专业气管切开术团队的促进者和障碍。
方法:使用系统评价和荟萃分析(PRISMA)的首选报告项目和约翰·霍普金斯大学护理循证实践模型的指导进行系统评价。
方法:我们的临床问题:跨专业气管造口术团队是否增加了说话瓣膜的使用,减少了说话和拔管的时间,不良事件,住院时间和死亡率?包括成人气管造口术患者的主要研究。合格的研究由两名审稿人系统审查,并由另外两名审稿人验证。
方法:MEDLINE,CINAHL和EMBASE。
结果:14项研究符合资格标准;主要是干预前后队列研究。说话瓣膜使用率增加的百分比为14%-275%;语音中位天数减少的百分比为33%-73%,拔管中位天数减少的百分比为26%-32%;不良事件发生率减少的百分比为32%-88%;住院天数减少的百分比为18-40天;ICU总住院时间和死亡率无显著变化。促进者包括团队教育,覆盖范围,轮,标准化,通信,领导人员和自动化,病人跟踪;障碍是财政上的。
结论:气管切开术的患者接受了专业的跨专业团队的护理,在一些临床结果方面表现出改善。
结论:来自严格,有必要进行控制良好且动力充足的研究,以及促进更广泛采用跨专业气管造口术团队策略的实施策略。专业的气管造口术团队与提高安全性和护理质量相关。
结论:综述证据为更广泛地实施跨专业气管造口术团队提供了依据。
■未经荟萃分析的PRISMA和合成(SWiM)。
■无。
OBJECTIVE: To systematically locate, evaluate and synthesize evidence regarding effectiveness of interprofessional tracheostomy teams in increasing speaking valve use and decreasing time to speech and decannulation, adverse events, lengths of stay (intensive care unit (ICU) and hospital) and mortality. In addition, to evaluate facilitators and barriers to implementing an interprofessional tracheostomy team in hospital settings.
METHODS: Systematic
review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Johns Hopkins Nursing Evidence-Based Practice Model\'s guidance.
METHODS: Our clinical question: Do interprofessional tracheostomy teams increase speaking valve use and decrease time to speech and decannulation, adverse events, lengths of stay and mortality? Primary studies involving adult patients with a tracheostomy were included. Eligible studies were systematically reviewed by two reviewers and verified by another two reviewers.
METHODS: MEDLINE, CINAHL and EMBASE.
RESULTS: Fourteen studies met eligibility criteria; primarily pre-post intervention cohort studies. Percent increase in speaking valve use ranged 14%-275%; percent reduction in median days to speech ranged 33%-73% and median days to decannulation ranged 26%-32%; percent reduction in rate of adverse events ranged 32%-88%; percent reduction in median hospital length of stay days ranged 18-40 days; no significant change in overall ICU length of stay and mortality rates. Facilitators include team education, coverage, rounds, standardization, communication, lead personnel and automation, patient tracking; barrier is financial.
CONCLUSIONS: Patients with tracheostomy who received care from a dedicated interprofessional team showed improvements in several clinical outcomes.
CONCLUSIONS: Additional high-quality evidence from rigorous, well-controlled and adequately powered studies are necessary, as are implementation strategies to promote broader adoption of interprofessional tracheostomy team strategies. Interprofessional tracheostomy teams are associated with improved safety and quality of care.
CONCLUSIONS: Evidence from
review provides rationale for broader implementation of interprofessional tracheostomy teams.
UNASSIGNED: PRISMA and Synthesis Without Meta-analysis (SWiM).
UNASSIGNED: None.