Extracorporeal Membrane Oxygenation Appropriateness: An Interdisciplinary Consensus-Based Approach.

Autor: Nurok M; From the Department of Surgery, Cedars-Sinai Heart Institute, Los Angeles, California., Warsh J; Harvard Business School, Boston, Massachusetts., Griner T; Critical Care Nursing, Cedars-Sinai Medical Center, Los Angeles, California., Kharabi M; Human Centered Design, Cedars-Sinai Medical Center, Los Angeles, California., Castongia J; Human Centered Design, Cedars-Sinai Medical Center, Los Angeles, California., Overbeck C; Human Centered Design, Cedars-Sinai Medical Center, Los Angeles, California., Krueger L; Department of Social Work, Cedars-Sinai Medical, Los Angeles, California., Coleman B; Critical Care Nursing, Cedars-Sinai Medical Center, Los Angeles, California., Ramzy D; From the Department of Surgery, Cedars-Sinai Heart Institute, Los Angeles, California., Chung J; From the Department of Surgery, Cedars-Sinai Heart Institute, Los Angeles, California., Chan A; Critical Care Nursing, Cedars-Sinai Medical Center, Los Angeles, California., Ley E; From the Department of Surgery, Cedars-Sinai Heart Institute, Los Angeles, California., Kubendran S; Department of Clinical Transformation, Cedars-Sinai, Los Angeles, California., Parrish N; Department of Clinical Transformation, Cedars-Sinai, Los Angeles, California., Yu Z; Department of Clinical Transformation, Cedars-Sinai, Los Angeles, California., Langberg M; Department of Medical Affairs, Cedars-Sinai Medical Center, Los Angeles, California., Finder S; Center for Healthcare Ethics, Cedars-Sinai Medical Center, Los Angeles, California., Rosen BT; Supportive Care Medicine and Physician Alignment & Care Transitions, Cedars-Sinai Medical Center, Los Angeles, California., Kaplan RS; Harvard Business School, Boston, Massachusetts., Sax H; From the Department of Surgery, Cedars-Sinai Heart Institute, Los Angeles, California., Arabia F; From the Department of Surgery, Cedars-Sinai Heart Institute, Los Angeles, California.
Jazyk: angličtina
Zdroj: Anesthesia and analgesia [Anesth Analg] 2019 Mar; Vol. 128 (3), pp. e38-e41.
DOI: 10.1213/ANE.0000000000002723
Abstrakt: We describe a quality improvement initiative aimed at achieving interdisciplinary consensus about the appropriate delivery of extracorporeal membrane oxygenation (ECMO). Interdisciplinary rounds were implemented for all patients on ECMO and addressed whether care was consistent with a patient's minimally acceptable outcome, maximally acceptable burden, and relative likelihood of achieving either. The rounding process was associated with decreased days on venoarterial ECMO, from a median of 6 days in 2014 (first quartile [Q1]-third quartile [Q3], 3-10) to 5 days in 2015 (Q1-Q3, 2.5-8) and in 2016 (Q1-Q3, 1-8). Our statistical methods do not allow us to conclude that this change was due to our intervention, and it is possible that the observed decreases would have occurred whether or not the rounding process was implemented.
Databáze: MEDLINE