呼吸衰竭护士顾问模式可能减少急性呼吸衰竭的住院天数：一项单中心描述性实施研究。

文献信息

中文摘要

目的： 无创通气已成为急性和慢性呼吸衰竭的成熟治疗方法。借助远程监测的潜力，无创通气的使用改善了无需与患者实际接触即可治疗慢性呼吸衰竭的可能性。本研究的目的是描述呼吸科顾问护士模式的实施和活动，并基于预定义假设估计其潜在的直接预算影响。
背景：
地点： 芬兰的一所大学医院。
参与者： 所有在非呼吸科病房需要启动无创通气或调整设置的患者。这些患者大多患有急性或慢性急性加重的髙碳酸血症性呼吸衰竭。基础诊断包括慢性阻塞性肺疾病、肥胖低通气综合征和阻塞性睡眠呼吸暂停。因神经肌肉疾病导致慢性呼吸衰竭的患者被排除。
方法： 这是一项在芬兰大学医院进行的单中心描述性实施研究。我们实施了一种呼吸衰竭顾问护士模式，其主要任务是在非呼吸科医院病房启动无创通气和进行随访访视、电话咨询、对非呼吸科医院病房的患者以及所有出院患者（包括在呼吸科病房启动无创通气的患者）进行无线远程监测、通过电话为患者提供咨询，以及为门诊患者更换破损或不合适的面罩或设备。呼吸衰竭顾问护士的活动数据从2019年到2022年前瞻性收集。直接预算影响基于估计的住院天数变化进行估算，这些变化源自每名患者的平均住院时间、患者费用、工资成本和远程监测许可证。
结果： 2019-2022年期间，共有240名患者在非呼吸科病房启动了无创通气。在呼吸衰竭护士的帮助下于非呼吸科病房启动无创通气，并用无线远程监测、家庭血氧测定和毛细血管血气分析替代住院随访访视，与2019年、2020年、2021年和2022年每名患者每年估计的潜在净预算影响分别为466.57欧元、1017.35欧元、1233.80欧元和1219.67欧元相关。在研究期间，启动无创通气的患者在呼吸科病房的过夜随访访视次数减少了61%。
结论： 使用呼吸衰竭顾问护士模式和无线远程监测更新呼吸衰竭患者的标准操作程序，与改善的护理提供以及估计的潜在住院天数和直接成本减少相关。

英文摘要

OBJECTIVES: Non-invasive ventilation has become a well-established treatment for both acute and chronic respiratory failure. With the potential of telemonitoring, the use of non-invasive ventilation has improved the possibilities of treating chronic respiratory failure without physical contact with patients. The aim of this study was to describe the implementation and activities of a consulting respiratory nurse model and to estimate its potential direct budget impact based on predefined assumptions.
SETTING: A University hospital in Finland.
PARTICIPANTS: All consecutive patients requiring non-invasive ventilation initiation or setting adjustment in non-pulmonary wards. Most of these patients had acute or acute-on-chronic hypercapnic respiratory failure. The underlying diagnoses included chronic obstructive pulmonary disease, obesity hypoventilation syndrome, and obstructive sleep apnea. Patients with chronic respiratory failure due to neuromuscular diseases were excluded.
METHODS: This was a single-centre descriptive implementation study conducted in a Finnish university hospital. We implemented a consulting respiratory failure nurse model, whose main tasks were non-invasive ventilation initiation and follow-up visits in non-pulmonary hospital wards, consultations by phone, wireless telemonitoring of patients in non-pulmonary hospital wards and all discharged patients including those initiating non-invasive ventilation in pulmonary wards, counselling patients by phone, and replacement of a broken or unsuitable mask or device for outpatients.Data on activities of a consulting respiratory failure nurse were prospectively collected from 2019 to 2022. The direct budget impact was estimated based on changes in the estimated number of in-hospital days derived from the average hospital stay per patient, patient fees, costs of salaries, and telemonitoring licenses.
RESULTS: A total of 240 patients initiated non-invasive ventilation in non-pulmonary wards during 2019-2022. Initiating non-invasive ventilation in non-pulmonary wards with the help of respiratory failure nurse and replacing in-hospital follow-up visits with wireless telemonitoring, home oximetry and capillary blood gas analyses, associated with an estimated potential net budget impact per patient per year of 466.57 €, 1017.35 €, 1233.80 € and 1219.67 € in year 2019, 2020, 2021 and 2022, respectively. The number of overnight follow-up visits in pulmonary ward among patients initiating non-invasive ventilation decreased by 61 % during the study period.
CONCLUSIONS: Updating the standard operating procedure for respiratory failure patients using the consulting respiratory failure nurse model and wireless telemonitoring was associated with improved care delivery and estimated potential reduction in-hospital days and direct costs.