소아심장외과 중환자실에서의 실무의사소통 프로토콜이 수술 후 성과에 미치는 영향 = Practical Communication Strategies to Improve the Surgical Outcomes in a Pediatric Cardiac Intensive Care Unit

국문 초록 (Abstract)

본 연구는 소아심장외과 중환자실에서의 실무의사소통 프로토콜 적용 후 환자 위해사건 발생에 대한 성과를 확인하는데 그 목적이 있다. 소아심장수술 후 중환자실 입원환자를 대상으로 수술 후 인계 기록지와 당일 치료목표 기록지를 작성하는 실무의사소통 프로토콜 수립 전(216명)과 적용 후(156명) 소아심장외과 중환자실에서의 위해사건 발생률을 비교하였다. 일반병동에서 중환자실로의 재입실률이 프로토콜 적용 전 6.0%에서 적용 후 0.6%로 감소하였으며(χ2=7.23, p=.010), 중환자실 주요 합병증 발생률도 4.2%에서 0.6%로 감소하였다(χ2=6.66, p=.012). 중재 누락과, 처방 오류 등 경미한 위해사건 발생건수 또한 100재원일 당 23.3건에서 7.5건으로 감소하였다(χ2=20.31, p<.001). 따라서 인수인계 프로토콜 적용이 심장 수술 후 중환자실의 위해사건 발생률 감소에 긍정적으로 영향을 미치는 것을 확인할 수 있었다. 임상 실무에서의 효과적인 의사소통 전략 개발을 위한 노력과 의사소통 전략의 환자 위해사건 발생에 미치는 성과 연구를 제안한다

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study is was to identify the impact of practical communication strategies (PCS) on the reduction of AEs (Adverse Events) in pediatric cardiac ICU (PCICU). Methods: Intra-operative findings and care plans were documented and shared between the staff members on a daily basis from the day of operation to the day of general ward transfer. The iIncidence of AEs was investigated in all patients who were admitted to the PCICU and was compared with the incidence of AEs one year after the establishment of PCS. Results: Our The study population consisted of 216 patients in pre-PCS group and 156 patients in post-PCS group. The iIncidence of readmission decreased from 6.0% (13/216) in pre-PCS group to 0.6% (1/156) in post-PCS group (χ2=7.23, p=.010). The iIncidence of other major complications decreased from 4.2% (9/216) to 0.6% (χ2=6.66, p=.012). Minor AEs such as intervention omission, order error, and protocol misunderstanding of the protocol were reduced from 23.3 cases per 100 patient-days to 7.5 cases per 100 patient-days (χ2=20.31, p< .001). Conclusions: Handover protocol is an effective strategy to reduce AEs for critically ill patients after pediatric cardiac surgery. Efforts to develop effective communication strategies should be continued and outcomes research about communication strategies for patient safety should be further studied.

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