背景:为了减少与中心静脉导管(CVC)插入相关的并发症,使用受监督的程序日志的当地认证计划是必不可少的。为了提高对这种日志的合规性,移动应用程序可以为成人重症监护病房(ICU)的医生培训提供理想的平台.
目的:本文的目的是将受训者的合规性与完成日志作为CVC插入认证计划的一部分进行比较,在引入基于应用程序的日志之前和之后。
方法:这是一项对日志数据的回顾性观察研究,在引入专用建筑之前和之后,基于应用程序,电子日志,以补充现有的纸质日志。在约翰·亨特医院的成人ICU进行了2年的时间,纽卡斯尔,新南威尔士州,澳大利亚,参与者是完成CVC插入认证计划的ICU实习医务人员.主要结果是患者电子病历中记录的所有CVC插入的比例,显示为日志条目。要评估日志录入质量,我们测量并比较了由主管批准的日志条目的比例,并包含了主管在前后期间的签名。我们还通过比较活跃日志用户的总数来分析干预前后的受训者参与情况。以及首次登录3次或更多CVC插入的用户的比例。
结果:在2019年4月7日至2021年4月6日之间电子病历中记录的2987次CVC插入中,包括2161次(72%),并在应用引入之前和之后分为队列。在介绍基于应用程序的日志之后,作为日志条目出现的CVC插入的百分比从3.6%(38/1059)增加到20.5%(226/1102;P<.001)。在引入应用程序之前和之后,包含主管签名的主管批准条目的比例没有差异,76.3%(29/38)和83.2%(188/226),分别(P=.31)。应用推出后,活跃日志用户的百分比从15.3%(13/85)增加到62.8%(54/86;P<.001)。两组中坚持自己的日志的情况相似,前一组中有60%(6/10)的首次用户和后组中有79.5%(31/39)的首次用户继续记录至少3个或更多的CVC在ICU工作期间。
结论:在已有的纸质日志中添加基于电子应用程序的日志与在成人ICU中进行CVC插入认证计划的见习医生的日志依从性较高相关。观察到的日志使用大大增加,而日志条目的质量却没有降低。总体受训者的参与也有所改善,观察到活跃日志用户的增加,并且在引入该应用程序后,每个用户的平均条目数没有减少。有必要对ICU程序认证计划的基于应用程序的日志进行进一步研究。
BACKGROUND: To reduce complications associated with central venous catheter (CVC) insertions, local accreditation programs using a supervised procedural logbook are essential. To increase compliance with such a logbook, a mobile app could provide the ideal platform for training doctors in an adult intensive care unit (ICU).
OBJECTIVE: The aim of this paper was to compare trainee compliance with the completion of a logbook as part of a CVC insertion accreditation program, before and after the introduction of an app-based
logbook.
METHODS: This is a retrospective observational study of logbook data, before and after the introduction of a purpose-built, app-based, electronic logbook to complement an existing paper-based
logbook. Carried out over a 2-year period in the adult ICU of the John Hunter Hospital, Newcastle, NSW, Australia, the participants were ICU trainee medical officers completing a CVC insertion accreditation program. The primary outcome was the proportion of all CVC insertions documented in the patients\' electronic medical records appearing as logbook entries. To assess
logbook entry quality, we measured and compared the proportion of
logbook entries that were approved by a supervisor and contained a supervisor\'s signature for the before and after periods. We also analyzed trainee participation before and after the intervention by comparing the total number of active logbook users, and the proportion of first-time users who logged 3 or more CVC insertions.
RESULTS: Of the 2987 CVC insertions documented in the electronic medical records between April 7, 2019, and April 6, 2021, 2161 (72%) were included and separated into cohorts before and after the app\'s introduction. Following the introduction of the app-based
logbook, the percentage of CVC insertions appearing as
logbook entries increased from 3.6% (38/1059) to 20.5% (226/1102; P<.001). There was no difference in the proportion of supervisor-approved entries containing a supervisor\'s signature before and after the introduction of the app, with 76.3% (29/38) and 83.2% (188/226), respectively (P=.31). After the introduction of the app, there was an increase in the percentage of active logbook users from 15.3% (13/85) to 62.8% (54/86; P<.001). Adherence to one\'s logbook was similar in both groups with 60% (6/10) of first-time users in the before group and 79.5% (31/39) in the after group going on to log at least 3 or more CVCs during their time working in ICU.
CONCLUSIONS: The addition of an electronic app-based logbook to a preexisting paper-based
logbook was associated with a higher rate of
logbook compliance in trainee doctors undertaking an accreditation program for CVC insertion in an adult ICU. There was a large increase in
logbook use observed without a reduction in the quality of
logbook entries. The overall trainee participation also improved with an observed increase in active logbook users and no reduction in the average number of entries per user following the introduction of the app. Further studies on app-based logbooks for ICU procedural accreditation programs are warranted.