护理流程再造在老年髋部骨折救治绿色通道中的实施及效果评价
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摘要
目的评价护理流程再造在老年髋部骨折救治绿色通道建设中的应用效果。方法回顾性分析2016年1月至2017年6月我院创伤中心收治的60岁以上髋部骨折(排除病理性骨折、双侧骨折及多发伤)并获得12个月随访的128例病人的临床资料,男52例,女76例。按护理流程分为再造后护理流程组(观察组)和常规护理流程组(对照组),各64例。记录两组病人的手术等待时间、术后首次下床活动时间和住院时间,观察两组病人出院时及术后6、12个月Harris髋关节功能评分,并进行组间统计学分析。结果观察组手术等待时间(中位数44.3h)明显短于对照组(中位数137.6 h),差异具有统计学意义(P<0.001);观察组术后首次下床活动时间为(2.24±0.48)d,对照组为(3.51±0.31)d,差异具有统计学意义(P<0.001);观察组住院时间为(12.78±1.51)d,对照组为(15.25±1.31)d,差异具有统计学意义(P<0.001);术后6、12个月,观察组Harris髋关节功能评分均明显优于对照组,差异均有统计学意义(P均<0.001)。结论在老年髋部骨折救治绿色通道建设中优化护理流程能减少病人手术等待时间和缩短住院时间,有利于病人早期下床进行功能锻炼及髋关节功能的恢复,再造后护理流程具有临床推广的意义。
Objective To evaluate the effect of nursing process reengineering in the construction of green passage for elderly hip fracture.Methods A retrospective analysis was performed on 128 patients with hip fracture over 60 years old(excluding pathological fracture, bilateral fracture and multiple injuries) admitted to Trauma Center of our hospital from January 2016 to June 2017. The clinical data were followed up for 12 months. There were 52 males and 76 females. According to the nursing process, the patients were divided into two groups: the reengineering nursing process group(observation group) and the routine nursing process group(control group), 64 cases in each group. The waiting time for operation, the first time to get out of bed and the hospital stay were recorded. The Harris hip function score at discharge, 6 and 12 months after operation was observed and analyzed statistically between the two groups.Results The waiting time(median 44.3 h) in the observation group was significantly shorter than that in the control group(median 137.6 h) with the difference being statistically significant(P<0.001). The first time out of bed activity time was(2.24±0.48) days in the observation group and(3.51±0.31) days in the control group, with the difference being statistically significant(P<0.001). The hospital stay in the observation group was(12.78±1.51) days, and(15.25±1.31) days in the control group, with the difference being statistically significant(P<0.001). At 6 th and 12 th month after operation, the Harris hip function score in the observation group was significantly higher than that in the control group, with statistical significance(all P<0.001).Conclusion The optimization of nursing process in green channel for treatment of hip fracture in elderly patients can reduce the patient's waiting time and the average hospital stay. It is beneficial to the early bed function exercise and the recovery of the hip function of the patients. This model has the significance of clinical practice promotion.
Objective To evaluate the effect of nursing process reengineering in the construction of green passage for elderly hip fracture.Methods A retrospective analysis was performed on 128 patients with hip fracture over 60 years old(excluding pathological fracture, bilateral fracture and multiple injuries) admitted to Trauma Center of our hospital from January 2016 to June 2017. The clinical data were followed up for 12 months. There were 52 males and 76 females. According to the nursing process, the patients were divided into two groups: the reengineering nursing process group(observation group) and the routine nursing process group(control group), 64 cases in each group. The waiting time for operation, the first time to get out of bed and the hospital stay were recorded. The Harris hip function score at discharge, 6 and 12 months after operation was observed and analyzed statistically between the two groups.Results The waiting time(median 44.3 h) in the observation group was significantly shorter than that in the control group(median 137.6 h) with the difference being statistically significant(P<0.001). The first time out of bed activity time was(2.24±0.48) days in the observation group and(3.51±0.31) days in the control group, with the difference being statistically significant(P<0.001). The hospital stay in the observation group was(12.78±1.51) days, and(15.25±1.31) days in the control group, with the difference being statistically significant(P<0.001). At 6 th and 12 th month after operation, the Harris hip function score in the observation group was significantly higher than that in the control group, with statistical significance(all P<0.001).Conclusion The optimization of nursing process in green channel for treatment of hip fracture in elderly patients can reduce the patient's waiting time and the average hospital stay. It is beneficial to the early bed function exercise and the recovery of the hip function of the patients. This model has the significance of clinical practice promotion.
引文
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[9]Khan SK,Kalra S,Khanna A,et al.Timing of surgery for hip fractures:a systematic review of 52 published studies involving 291,413 patients[J].Injury,2009,40(7):692-697.
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[2]Shiga T,Wajima Z,Ohe Y.Is operative delay associated with increased mortality of hip fracture patients?Systematic review,metaanalysis,and meta-regression[J].Can J Anaesth,2008,55(3):146-154.
[3]李继川,赵义荣,俞春生,等.绿色通道在老年髋部骨折临床治疗中的应用研究[J].新中医,2016,48(11):84-86.
[4]曹烈虎,汪琳,陈晓,等.绿色通道建设提高高龄髋部骨折患者治疗的有效性与安全性[J].第二军医大学学报,2017,38(4):421-425.
[5]王自洲,崔波.绿色通道在老年髋部骨折诊治中的效果分析[J].中国医药指南,2018,16(3):150-151.
[6]Gupta A.The effectiveness of geriatrician-led comprehensive hipFracture collaborative care in a new acute hip unit based in a general hospital setting in the UK[J].J R Coll Physicians Edinb,2014,44(1):20-26.
[7]Leung AH,Lam TP,Cheung WH,et al.An orthogeriatric collaborative intervention program for fragility fractures:a retrospective cohort study[J].J Trauma,2011,71(5):1390-1394.
[8]Flikweert ER,Izaks GJ,Knobben BA,et al.The development of a comprehensive multidisciplinary care pathway for patients with a hip fracture:design and results of a clinical trial[J].BMC Musculoskelet Disord,2014(15):188.
[9]Khan SK,Kalra S,Khanna A,et al.Timing of surgery for hip fractures:a systematic review of 52 published studies involving 291,413 patients[J].Injury,2009,40(7):692-697.
[10]徐慧萍,赵辉,刘延锦.老年髋部骨折患者快速康复方案的临床实施[J].护理学杂志,2016,31(10):29-32.