■一家为住院患者提供现成脊柱矫形器的外部供应商为脊柱手术患者的优质护理带来了巨大的成本和障碍。护理领导团队发起了一项质量改进项目,以降低提供现成脊柱矫形器的成本,并改善对脊柱患者的护理。
■开发和评估以护理为主导的过程,为脊柱手术患者提供现成的矫形器,并消除高昂的成本。
■质量改进项目评估为回顾性中断时间序列。
■位于佛罗里达州一家美国医院的术后住院二级创伤中心。
■供应商计划:134名患者;集中计划:155名患者。
护理领导团队开发了一个集中式脊柱矫形器项目,床边护士为患者安装了脊柱矫形器,消除了对外部矫形师的需要。该研究通过比较通过图表审查确定的在供应商计划中接受护理的患者与在集中计划中接受护理的患者,利用非参数统计技术,量化了研究指标的变化。
■集中护理主导的脊柱矫形器计划使该单位能够比在供应商计划下管理的患者更快地动员患者(3.85小时。[95%CI:1.27至7.26小时]减少;p=0.004)。总住院时间减少了0.78天([1.34-0.02天];p=0.063)或18.72小时。虽然统计检验没有显著性,住院时间缩短18.72小时是一个潜在的临床相关发现.评估患有原发性脊柱损伤且无并发症的患者(供应商计划:54名患者;集中计划:86名患者)显示出类似的动员时间减少(减少4.5小时[0.53至12.93小时];p=0.025),但停留时间减少增加到1.02天[0.12到1.97天],差异被确定为统计学上显著的(p=0.014)。集中提供现成的脊柱矫形器的过程,使胸腰椎骶骨矫形器的成本降低了1,483美元,腰椎骶骨矫形器的价格降低了1,327美元。在整个研究过程中,新计划将提供脊柱矫形器的成本降低了175,319美元。
■结果表明,以护理为主导的集中式脊柱矫形器计划对患者提供的护理质量产生了积极影响,同时还降低了提供矫形器的成本。
■以护理为主导的集中式脊柱矫形器计划降低了护理成本,同时减少了动员时间和住院时间。
UNASSIGNED: An external vendor providing off-the-shelf spinal orthoses to inpatients created significant costs and barriers to quality care for spinal surgery patients. A nursing leadership team initiated a quality improvement project to reduce the cost of providing off-the-shelf spinal orthoses and improve the care provided to spinal patients.
UNASSIGNED: To develop and evaluate a nursing-led process for providing off-the-shelf orthoses to spinal surgery patients and eliminate high costs.
UNASSIGNED: Quality improvement project evaluated as a retrospective interrupted time-series.
UNASSIGNED: Post Surgery Inpatient Unit Level II Trauma Center in a United States hospital located in Florida.
UNASSIGNED: Vendor Program: 134 patients; Centralized Program: 155 patients.
UNASSIGNED: The nursing leadership team developed a centralized spinal orthoses program where the bedside nurse fitted the patient with a spinal orthosis, eliminating the need for an external orthotist. The study quantifies changes in study metrics by comparing patients identified through chart review who received care in the vendor program to those who received care in the centralized program utilizing nonparametric statistical techniques.
UNASSIGNED: The centralized nursing-led spinal orthosis program allowed the unit to mobilize patients more quickly than patients managed under the vendor program (3.85 hr. [95 % CI: 1.27 to 7.26 hrs] reduction; p = 0.004). The overall length of stay was reduced by 0.78 days ([1.34 - 0.02 days]; p = 0.063) or 18.72 h. While the statistical test did not indicate significance, the 18.72-hour reduction in length of stay represents a potential clinically relevant finding. Evaluating patients that suffered a primary spinal injury and no complications (vendor program: 54 patients; centralized program: 86 patients) showed a similar reduction in time to mobilization (4.5 hr reduction [0.53 to 12.93 hrs]; p = 0.025), but the length of stay reduction increased to 1.02 days [0.12 to 1.97 days], a difference determined to be statistically significant (p = 0.014). Centralizing the process for providing off-the-shelf spinal orthoses reduced the cost of a thoracic-lumbar sacral orthosis by $1,483 and the price of a lumbar-sacral orthosis by $1,327. Throughout the study, the new program reduced the cost of providing spinal orthoses by $175,319.
UNASSIGNED: The results demonstrate that the nursing-led centralized spinal orthosis program positively impacted the quality of care provided to our patients while also reducing the cost of delivering the orthoses.
UNASSIGNED: A nursing-led centralized spinal orthosis program reduces the cost of care while reducing time to mobilization and length of stay.