Clinical Audit

临床审核
  • 文章类型: Journal Article
    困难的气道管理是儿科麻醉的主要挑战之一,特别是在低收入和中等收入国家。
    本研究的目的是探讨儿科插管困难的主要预测因素。
    在这项观察性研究中,我们纳入了所有5岁以下接受气管插管的腹内手术的儿童.根据插管困难的发生率将患者分为两组。然后,我们调查了儿科困难插管的预测因素.
    我们包括217个孩子,在其中10%的患者中观察到困难的插管。预测因素如下:MallampatiIII-IV级(调整后的比值比=2.21;95%置信区间=1.1-6.4),张口受限(调整后的赔率比=2.4;95%置信区间=1.8-3.5),面部畸形(调整后的比值比=2.6;95%置信区间=1.32-7.4)和无肌肉松弛剂麻醉(调整后的比值比=1.8;95%置信区间=1.0-5.1)或无阿片类药物麻醉(调整后的比值比=1.7;95%置信区间=1.01-4.8).
    面部畸形和张口受限是儿童插管困难的预测因素。此外,Mallampati类和麻醉技术似乎也可以预测具有挑战性的插管,这可能会指导我们改变围手术期的做法。
    UNASSIGNED: Difficult airway management is one of the main challenges in paediatric anaesthesia, particularly in low- and middle-income countries.
    UNASSIGNED: The aim of this study was to investigate the main predictors of difficult paediatric intubation.
    UNASSIGNED: In this observational study, we included all children aged less than five years undergoing intra-abdominal surgery with endotracheal intubation. Patients were divided into two groups according to the incidence of difficult intubation. Then, we investigated predictors for difficult paediatric intubation.
    UNASSIGNED: We included 217 children, and difficult intubation was observed in 10% of them. Predictors were as follows: Mallampati III-IV class (adjusted odds ratio = 2.21; 95% confidence interval = 1.1-6.4), limited mouth opening (adjusted odds ratio = 2.4; 95% confidence interval = 1.8-3.5), facial dysmorphia (adjusted odds ratio = 2.6; 95% confidence interval = 1.32-7.4) and anaesthesia without muscle relaxant (adjusted odds ratio = 1.8; 95% confidence interval = 1.0-5.1) or without opioids during crash inductions (adjusted odds ratio = 1.7; 95% confidence interval = 1.01-4.8).
    UNASSIGNED: Facial dysmorphia and limited mouth opening were predictors of difficult intubation in children. Furthermore, it seems that Mallampati class and anaesthesia technique may also predict challenging intubation, which may guide us to change our perioperative practice.
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  • 文章类型: Journal Article
    静脉患者自控镇痛(PCA)对于灵活及时地提供阿片类药物非常有价值。尽管它旨在提供由患者自己驱动的个性化镇痛,用户经常报告疼痛缓解不足,可以通过优化其设置和多模式镇痛来解决。我们采用了一种系统的方法,通过利用基于机构PCA数据的串行审核过程来修改PCA协议。这篇综述回顾了这一过程,包括来自使用PCA设备的13,230名患者的数据。对基于芬太尼的PCA方案的两个修改导致三个不同的阶段。在第一阶段,阿片类药物的高消费量和PCA的意外戒断是常见的问题。在第二阶段通过省略基础输注的常规使用来解决这些问题。然而,这导致交付需求比率增加,在第三阶段,通过将推注剂量从15μg增加到20μg来减轻。这些系列方案的变化在不同的外科部门产生了不同的结果,强调需要进行仔细和逐步的调整和彻底的影响评估。从这个审计过程中汲取见解,我们纳入了文献中有关PCA设置和多模式镇痛方法的研究结果.这篇综述强调了迭代反馈和完善镇痛方案对实现最佳术后疼痛管理的重要性。此外,它讨论了关于术后审核过程的关键考虑因素。
    Intravenous patient-controlled analgesia (PCA) is valuable for delivering opioids in a flexible and timely manner. Although it is designed to offer personalized analgesia driven by the patients themselves, users often report insufficient pain relief, which can be addressed by optimizing its settings and multimodal analgesia. We adopted a systematic approach to modify PCA protocols by utilizing a serial audit process based on institutional PCA data. This review retrospectively examined the process, encompassing data from 13,230 patients who had used PCA devices. The two modifications to the fentanyl-based PCA protocols resulted in three distinct phases. In the first phase, high opioid consumption and unintended PCA withdrawal were the common issues. These were addressed in the second phase by omitting the routine use of basal infusion. However, this led to increased delivery-to-demand ratios, mitigated in the third phase by increasing the bolus dose from 15 μg to 20 μg. These serial protocol changes have produced varied outcomes across different surgical departments, underscoring the need for careful and gradual adjustments and thorough impact assessments. Drawing insights from this audit process, we incorporated findings from the literature on PCA settings and multimodal analgesic approaches. This review underscores the significance of iterative feedback and refinement of analgesic protocols to achieve optimal postoperative pain management. Additionally, it discusses critical considerations regarding the postoperative audit processes.
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  • 文章类型: Journal Article
    背景:优化初级保健患者是在社区内管理患者护理并减轻二级保健转诊负担的主要机会。本文介绍了在NHS初级保健网络中进行的质量改进临床计划,作为更广泛的莱斯特莱斯特郡拉特兰综合慢性肾脏疾病计划的一部分。
    方法:患者根据美国国家健康与护理卓越研究所的指南进行了优化,由肾脏病学顾问和肾脏病学药剂师支持的初级保健临床团队。与二级保健专家和初级保健人员举行多学科小组会议。学习传递给社区临床医生,以便在当地更好地治疗患者。
    结果:本项目共对526例患者进行了回顾。首次门诊预约后出院的二级护理转诊总数,从42.9%降至10%。32.9%的减少代表了通过此质量改进项目对患者病例的优化。患者可以在社区内进行优化和管理,减少不必要的转诊到二级保健的数量。
    结论:当扩展到更大的患者基础时,该计划有可能提供患者预后的显着改善。在初级和二级保健中都优化了医学管理和临床人员的使用。
    BACKGROUND: The optimisation of patients in primary care is a prime opportunity to manage patient care within the community and reduce the burden of referrals on secondary care. This paper presents a quality improvement clinical programme taking place within an NHS Primary Care Network as part of the wider Leicester Leicestershire Rutland integrated chronic kidney disease programme.
    METHODS: Patients are optimised to guidelines from the National Institute for Health and Care Excellence, by a primary care clinical team who are supported by nephrology consultants and nephrology pharmacists. Multidisciplinary team meetings take place with secondary care specialists and primary care staff. Learning is passed to the community clinicians for better patient treatment locally.
    RESULTS: A total of 526 patients were reviewed under this project.The total number of referrals to secondary care which were discharged following first outpatient appointment, reduced from 42.9% to 10%. This reduction of 32.9% represents the optimisation of patient cases through this quality improvement project. Patients can be optimised and managed within the community, reducing the number of unnecessary referrals to secondary care.
    CONCLUSIONS: This programme has the potential to offer significant improvement in patient outcomes when expanded to a larger patient base. Medicine management and the use of clinical staff are optimised in both primary and secondary care.
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  • 文章类型: Journal Article
    背景:褪黑激素通常用于治疗儿童和青少年的睡眠障碍,尽管关于其最佳使用的不确定性仍然存在。
    目的:确定褪黑激素的处方在多大程度上符合循证临床实践标准。
    方法:作为质量改进计划的一部分,心理健康处方观察站对英国儿童和青少年服务进行了回顾性临床审核.
    结果:提交了4151名18岁以下儿童和青少年的数据,褪黑激素治疗:3053(74%)诊断为神经发育障碍。在3651例患者中,有2655例(73%)定期服用褪黑激素,主要原因是减少睡眠潜伏期(入睡所需的时间)。在409名最近开始使用褪黑激素的患者中,已在279例(68%)中尝试了非药物干预.早期治疗(n=899)和长期治疗(n=2353)的患者的治疗反应已得到评估和量化,分别为36%和31%。分别,在审查副作用时,分别为46%和43%。在长期治疗的患者中,有317例(13%)记录了计划的治疗中断。
    结论:褪黑素主要用于循证临床适应症,但是这种治疗的临床回顾和监测没有达到最佳实践.
    结论:对患者使用褪黑素的方法评价有限,临床医生将无法获得有关个体患者的风险和收益的可靠信息.缺乏这种基于实践的证据可能会增加褪黑激素被不适当地靶向或持续的风险,尽管是无效的或不再指示。
    BACKGROUND: Melatonin is commonly used to treat sleep disturbance in children and adolescents, although uncertainties about its optimal use remain.
    OBJECTIVE: To determine to what extent prescribing of melatonin complies with evidence-based clinical practice standards.
    METHODS: As part of a quality improvement programme, the Prescribing Observatory for Mental Health conducted a retrospective clinical audit in UK services for children and adolescents.
    RESULTS: Data were submitted for 4151 children and adolescents up to 18 years of age, treated with melatonin: 3053 (74%) had a diagnosis of neurodevelopmental disorder. In 2655 (73%) of the 3651 patients prescribed melatonin to be taken regularly, the main reason was to reduce sleep latency (time taken to fall asleep). In 409 patients recently starting melatonin, a non-pharmacological intervention had already been tried in 279 (68%). The therapeutic response of patients early in treatment (n=899) and on long-term treatment (n=2353) had been assessed and quantified in 36% and 31%, respectively, while for review of side effects, the respective proportions were 46% and 43%. Planned treatment breaks were documented in 317 (13%) of those on long-term treatment.
    CONCLUSIONS: Melatonin was predominantly prescribed for evidence-based clinical indications, but the clinical review and monitoring of this treatment fell short of best practice.
    CONCLUSIONS: With limited methodical review of melatonin use in their patients, clinicians will fail to garner reliable information on its risks and benefits for individual patients. The lack of such practice-based evidence may increase the risk of melatonin being inappropriately targeted or continued despite being ineffective or no longer indicated.
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  • 文章类型: Journal Article
    目的:本研究的目的是通过内部审计(IA)评估重症监护病房(CCU)零项目的实施情况。
    方法:设计:实时观察安全性分析。编制了一份带有明确项目的问卷,以确保客观性。在IAS之后,与审计员进行了调查。
    方法:ServizoGalegodeSaúde和Ribera-POVISA医院的11个CCU。
    方法:由医疗,护理,对来自卫生领域的质量人员和34例患者进行了评估。
    方法:符合质量标准(项目的≥60%),优势,需要改进的地方,审计师在IA中的权益,符合组织和项目。
    结果:100%CCU符合质量标准。18.03%的项目由所有CCU完成。优势:员工激励,积极接受审计师,以及在某些CCU中使用计算机工具。需要改进的地方:气管内导管袖带压力控制自动系统的缺陷(符合CCU的9.1%),培训需求,沟通问题,并且不使用检查表(占报告的45.5%)。审计师发现IA非常有趣,19%的人建议改进组织和项目。
    结论:所有CCU均符合先前商定的质量标准。确定了许多改进机会,并将其传达给已审计的CCU。为了更大的同质性和客观性,需要对先前商定的项目和定义进行审查。
    OBJECTIVE: The objective of this study was to assess the implementation of Zero Projects in Critical Care Units (CCUs) through Internal Audits (IA).
    METHODS: Design: Real-time observational safety analysis. A questionnaire was developed with defined items to ensure objectivity. After IAs, a survey was conducted with the auditors.
    METHODS: 11 CCUs in hospitals of the Servizo Galego de Saúde and Ribera-POVISA.
    METHODS: 24 auditors in 9 teams composed of medical, nursing, and quality personnel from health areas and 34 patients were assessed.
    METHODS: Compliance with the quality standard (≥60% of items), strengths, areas for improvement, auditor\'s interest in IA, conformity with the organization and items.
    RESULTS: 100% CCUs met the quality standard. 18.03% of items were fulfilled by all CCUs. Strengths: staff motivation, positive reception of auditors, and use of computer tools in some CCUs. Areas for improvement: deficit of automatic systems for controlling endotracheal tube cuff pressure (compliance rate in 9.1% of CCUs), training needs, communication issues, and not using checklists (45.5% of the reports). Auditors found IA very interesting, and 19% suggested improving organization and items.
    CONCLUSIONS: All CCUs met the previously agreed-upon quality standard. Numerous improvement opportunities were identified and communicated to the audited CCUs. For greater homogeneity and objectivity, a review of previously agreed items and definitions is required.
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    文章类型: Journal Article
    背景:在包括马来西亚在内的发展中国家,感染性心内膜炎(IE)的死亡率很高。这项临床审核旨在找出当地三级中心IE患者诊断和管理方面的缺陷,以实施改进措施。
    方法:这项回顾性审核分为两个周期-第一个周期包括沙捞越心脏中心的所有IE患者,马来西亚从2020年1月到2022年12月使用不同的参数(血液培养,超声心动图,抗生素和手术的适当性)根据马来西亚临床实践指南(CPG)进行评估;并于2023年7月至2023年12月进行重新审核。重新审核之前的干预措施包括在不同医院级别的演示和继续医学教育。
    结果:招募了50名患者(第一个周期为37名,在第二个周期中为13)。平均年龄为48.5岁,男性占优势。瓣膜假体(12.0%)和风湿性心脏病(10.0%)是最常见的诱发因素。天然二尖瓣(44.0%)和主动脉瓣(28.0%)最常见。28例(56.0%)患者为文化阳性。在第一个周期中,大多数参数(培养技术0.0%,植被测量为54.1%,经验5.4%,文化指导29.7%抗生素治疗,除超声心动图和血培养潜伏期的及时性外,指示手术0.0%)未达到预期标准。经过初步干预,在重新审核期间,所有参数均显示统计学上显著的改善(培养技术p<0.001,超声心动图p<0.001,经验p<0.001,文化引导p=0.021,手术p<0.001).
    结论:关于IE管理的临床实践指南(CPG)的符合性在第一次审核中表现欠佳,但在干预后有所改善。因此,定期继续医学教育(CME)至关重要,和书面的医院协议可能是有用的。定期审计与多学科团队合作是至关重要的努力。
    BACKGROUND: Infective endocarditis (IE) has a high mortality rate in developing countries including Malaysia. This clinical audit aims to identify the shortcomings in the diagnosis and management of IE patients in a local tertiary centre to implement changes for improvement.
    METHODS: This retrospective audit had two cycles - the first includes all IE patients in Sarawak Heart Centre, Malaysia from January 2020 to December 2022 with different parameters (blood culture, echocardiogram, the appropriateness of antibiotics and surgery) assessed against Malaysian Clinical Practice Guideline (CPG); and reaudit from July 2023 to December 2023. Interventions before re-audit include presentation at different hospital levels and continuing medical education.
    RESULTS: Fifty patients were recruited (37 in the first cycle, 13 in the second cycle). The median age was 48.5 years with male predominance. Valve prosthesis (12.0%) and rheumatic heart disease (10.0%) were the commonest predisposing factors. Native mitral (44.0%) and aortic valves (28.0%) were most commonly involved. Twenty-eight (56.0%) patients were culture-positive. In the first cycle, most parameters (culture technique 0.0%, vegetation measured 54.1%, empirical 5.4%, culture-guided 29.7% antibiotics therapy, indicated surgery 0.0%) did not achieve the expected standard except timeliness of echocardiograms and blood culture incubation period. After initial interventions, all parameters showed statistically significant improvement (culture technique p<0.001, echocardiography p<0.001, empirical p<0.001, culture-guided p=0.021, surgery p<0.001) during the re-audit.
    CONCLUSIONS: Compliance with clinical practice guidelines (CPG) on IE management was suboptimal during the first audit but improved after interventions. Hence, regular continuing medical education (CME) is essential, and a written hospital protocol may be useful. Regular audits alongside multidisciplinary teamwork are crucial efforts.
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  • 文章类型: Journal Article
    背景:由于眼科劳动力分布不均,澳大利亚农村地区的患者获得玻璃体内治疗的机会有限。为了改善访问,实施了一种新的外展服务模式,即初级医务人员在眼科顾问的监督下进行玻璃体内注射.这种模式涉及医院的外展访问,流动诊所和一个远程中心,由初级医生在眼科医生的监督下进行玻璃体内注射。本文探讨了这种方法在注射后眼内炎发生率方面的安全性。
    方法:2017年至2023年中期,LionsOutbackVision外展眼科服务进行了回顾性审核。注射次数,地点,诊断,使用的玻璃体内药物,对给药医生的指定和眼内炎的病例进行了回顾。
    结果:在6.5年期间,在整个西澳大利亚农村的32个地点进行了12632次玻璃体内注射。3例发生眼内炎,发生率为0.0237%。
    结论:外展服务中的眼内炎发生率与其他中心相当。通过亲自监督眼科顾问支持或通过远程医疗和初级医务人员注射管理的外展模式改善了服务不足或边缘化人群的获取。
    BACKGROUND: Patients in rural Australia have limited access to intravitreal treatments due to a maldistribution of the ophthalmology workforce. To improve access, a novel outreach service model was implemented whereby junior medical staff administered intravitreal injections under a supervising ophthalmology consultant. This model involves outreach visits in hospitals, mobile clinics and a remote hub with intravitreal injections administered by junior doctors overseen by an ophthalmologist. The article explores the safety of this approach with respect to the rate of post-injection endophthalmitis.
    METHODS: A retrospective audit was conducted by the Lions Outback Vision outreach ophthalmology service from 2017 to mid-2023. The number of injections, locations, diagnoses, intravitreal agents used, designation of administering doctor and cases of endophthalmitis were reviewed.
    RESULTS: A 12 632 intravitreal injections were administered across 32 locations throughout rural Western Australia in the 6.5-year period. Three cases of endophthalmitis occurred representing a rate of 0.0237%.
    CONCLUSIONS: The rate of endophthalmitis in the outreach service is comparable to other centres. The outreach model with supervising ophthalmology consultant support in person or via telehealth and administration of injections by junior medical staff has improved access for underserved or marginalised populations.
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  • 文章类型: Journal Article
    (1)研究背景:用药依从性受多种复杂因素的影响,为护士在患有慢性病的成年人中努力改善这一状况提供了障碍。查明不坚持的原因对于定制干预措施至关重要。该质量改进项目的目标是通过促进循证实践来提高初级卫生保健中患有慢性病的成年人的用药依从性。确定合规的障碍和促进者,并制定策略,通过参与护理团队来确保最佳的依从性,增强知识,并评估实施战略的有效性。(2)方法:本研究是一个质量改进项目,利用JBI证据实施框架,临床证据系统的实际应用,以及跨三个阶段的“实践研究”审计工具:(i)组建项目团队并进行基线审计,(ii)通过GRIP工具提供反馈,和(iii)进行后续审计以评估最佳实践结果。该研究于2021年9月至2022年3月在阿尔加维地区卫生管理局的社区护理单位进行,针对患有慢性疾病的成年人。(3)结果:共审计148人,包括8名护士,70名基线患者,和70名实施后患者。最初对关键最佳实践的遵守程度很低,在基线时具有0%依从性的几个标准。干预后,我们观察到显著的改进;对关键最佳实践的遵守显著提高,许多人达到100%。显著的改进包括加强患者对药物管理的教育,定期药物依从性评估,并增加了医疗保健专业人员在坚持活动中的参与度。(4)结论:这个质量改进项目表明,循证干预可显著提高患有慢性病的成人患者的用药依从性.该项目的成功凸显了类似策略在初级卫生保健环境中广泛应用以改善健康结果的潜力。
    (1) Background: Medication adherence is influenced by a variety of intricate factors, presenting hurdles for nurses working to improve it among adults with chronic conditions. Pinpointing the reasons for non-adherence is crucial for customizing interventions. The objective of this quality improvement project was to improve medication adherence among adults with chronic diseases in primary healthcare by promoting evidence-based practices, identifying barriers and facilitators to compliance, and developing strategies to ensure optimal adherence through engaging the nursing team, enhancing knowledge, and evaluating the effectiveness of the implemented strategies. (2) Methods: This study was a quality improvement project that utilized the JBI Evidence Implementation framework, the Practical Application of Clinical Evidence System, and the Getting Research into Practice audit tool across three phases: (i) forming a project team and conducting a baseline audit, (ii) offering feedback via the GRiP tool, and (iii) conducting a follow-up audit to assess best practice outcomes. The study was conducted between September 2021 and March 2022 in the community care unit of Algarve Regional Health Administration, targeting adults with chronic illnesses. (3) Results: A total of 148 individuals were audited, including 8 nurses, 70 baseline patients, and 70 post-implementation patients. Initial compliance with key best practices was low, with several criteria at 0% compliance at baseline. Post-intervention, we observed significant improvements; compliance with key best practices improved dramatically, with many reaching 100%. Notable improvements included enhanced patient education on medication management, regular medication adherence assessments, and increased engagement of healthcare professionals in adherence activities. (4) Conclusions: This quality improvement project demonstrated that structured, evidence-based interventions could significantly enhance medication adherence among adults with chronic diseases. The success of the project highlights the potential of similar strategies to be applied broadly in primary healthcare settings to improve health outcomes.
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  • 文章类型: Journal Article
    目标:在英国,指南建议对所有不可切除的胰腺癌患者进行胰酶替代疗法(PERT).2023年,我们发布了一项PERT的国家审计,该审计显示英格兰的处方欠佳,区域差异很大。本手稿的目的是描述我们如何使用PERT审计来推动医疗保健的改进。
    方法:建立在PERT审核的基础上,我们部署了一个在线仪表板,它将提供PERT审核的持续更新。我们与癌症护理专家(CNS)开发了一种协作干预措施,以改善对胰腺癌患者的护理。名为“创建一个NatiOnAL中枢神经系统胰腺癌网络以标准化和改进CarE(COALESCE)”的干预措施将使用仪表板来评估PERT处方的改进。
    结果:我们展示了如何使用大型电子医疗记录(EHR)数据库来改善癌症护理。PERT审计已实施到仪表板中,以跟踪COALESCE的进度。随着CNS干预的进展,我们将衡量PERT处方的改善。
    结论:改善医疗保健是一个持续和反复的过程。通过实施PERT仪表板,我们创造了一个资源高效的,自动评估方法,使COALESCE能够实现可持续的变化。国家规模的EHR数据库可实现快速的审计周期,为干预措施提供定期反馈,系统地工作以实现变革。这里,重点是胰腺癌。然而,这种方法可以转移到医疗保健的其他领域。
    结论:护士在收集高质量数据方面发挥着关键作用,这些数据是临床审计中发现医疗保健缺陷所必需的。护士驱动的干预措施可以用来改善医疗保健。在这项研究中,我们利用中枢神经系统为每一位癌症患者提供协调治疗的独特作用.COALESCE是第一个使用CNS作为研究人员和变革剂的国家合作研究。
    OBJECTIVE: In the UK, guidelines recommend pancreatic enzyme replacement therapy (PERT) to all people with unresectable pancreatic cancer. In 2023, we published a national audit of PERT which showed suboptimal prescribing and wide regional variation in England. The aim of this manuscript was to describe how we used the PERT audit to drive improvements in healthcare.
    METHODS: Building on the PERT audit, we deployed an online dashboard which will deliver ongoing updates of the PERT audit. We developed a collaborative intervention with cancer nurse specialists (CNS) to improve care delivered to people with pancreatic cancer. The intervention called Creating a natiOnAL CNS pancrEatic cancer network to Standardise and improve CarE (COALESCE) will use the dashboard to evaluate improvements in prescribing of PERT.
    RESULTS: We demonstrated how large databases of electronic healthcare records (EHRs) can be used to improve cancer care. The PERT audit was implemented into a dashboard for tracking the progress of COALESCE. We will measure improvements in PERT prescribing as the intervention with CNS progresses.
    CONCLUSIONS: Improving healthcare is an ongoing and iterative process. By implementing the PERT dashboard, we created a resource-efficient, automated evaluation method enabling COALESCE to deliver a sustainable change. National-scale databases of EHRs enable rapid cycles of audits, providing regular feedback to interventions, working systematically to deliver change. Here, the focus is on pancreatic cancer. However, this methodology is transferable to other areas of healthcare.
    CONCLUSIONS: Nurses play a key role in collecting good quality data which are needed in clinical audits to identify shortcomings in healthcare. Nurse-driven interventions can be designed to improve healthcare. In this study, we capitalize on the unique role of CNS coordinating care for every patient with cancer. COALESCE is the first national collaborative study which uses CNS as researchers and change agents.
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  • 文章类型: Journal Article
    提供给患者的护理中有多达40%是浪费或有害的。审计和反馈的实践可以帮助确定可以改善护理的地方。然而,此类审核必须以与临床医生合作的系统方式执行,以最大限度地提高反馈的影响,最终改善患者预后。目前,审计培训没有纳入正规的教育途径,临床医生需要指导以支持他们进行这项活动。本文探讨了当代研究,目的是为建议提供切实可行的建议,以最大限度地提高审计和反馈的影响。
    http://links。www.com/IJEBH/A239.
    UNASSIGNED: Up to 40% of care provided to patients is either wasteful or harmful. The practice of audit and feedback can help identify where care can be improved. However, such audits must be executed in a systematic way that engages with clinicians to maximize the impact of feedback, ultimately improving patient outcomes. Currently, audit training is not integrated into formal education pathways and clinicians need guidance to support them in this activity. This paper explores contemporary research, with the aim of providing practical advice for recommendations to maximize the impact of audit and feedback.
    UNASSIGNED: http://links.lww.com/IJEBH/A239.
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