Construction Of Nursing-Sensitive Quality Indicators System Of Full Process Of STEMI Care Based On Regional Cooperative Rescue Model

ObjectiveTo construct a nursing-sensitive quality indicators system for the full process of ST-segment elevation myocardial infarction based on the regional cooperative rescue model to provide a reference basis for monitoring and evaluating the quality of the whole process of pre-hospital emergency care,in-hospital treatment and post-hospital management of STEMI patients.Methods1.Systematically retrieve relevant literature on the quality of care evaluation of STEMI patients at home and abroad,organize,analyze and extract relevant sensitive indicators,and initially construct a nursing-sensitive quality indicators system for the full process of nursing care quality in STEMI.2.Using purposive sampling method,24 medical and nursing staffs from 7 hospitals with chest pain center qualification in Guangdong Province were selected to conduct semi-structured interviews to understand the focus and difficulties of STEMI total process nursing quality,extract the themes related to STEMI full process nursing quality sensitivity indicators,and supplementary the basis for constructing STEMI full process nursing quality sensitivity indicator system based on the regional cooperative rescue model.3.Organize expert group meetings to discuss the revision of the STEMI quality of care sensitivity indicators by screening the importance and expression of the indexes,and determine the STEMI full process quality of care sensitivity indicator system based on the regional cooperative rescue model.4.Two rounds of Delphi expert consultation with 22 experts were conducted to finalize an objective and scientific quality sensitivity indicator system for the full process of STEMI care based on the regional cooperative rescue model.5.Proportioning Method is adopted to calculate the index weights and establish the weights of each index and combination weights of the STEMI full process nursing-sensitive quality indicator system based on the regional cooperative rescue model.Results1.Through literature review,the index contents of 49 relevant papers were extracted,and the preliminary construction of a quality sensitivity indicator system for the full process of STEMI care based on the regional cooperative rescue model,including 3 primary indexes,12 secondary indexes and 40 tertiary indexes.2.The semi-structured interview distilled 7 themes and 18 sub-themes of personnel and equipment,management system,professionals kills,pre-hospital emergency,in-hospital cooperation,out-of-hospital follow-up,and continuous improvement,and 7 indicators were added to the STEMI sensitivity index system: clock unification program,process management,mastering the STEMI treatment process in chest pain center,humanistic care nursing,time point of STEMI treatment nursing,three meetings of quality control(joint meeting,quality analysis meeting,typical case discussion),and continuous improvement.3.After discussion and revision in the expert group meeting,the full process of STEMI care quality sensitivity indicator system based on the regional cooperative rescue model was formed,including 3 primary indexes,12 secondary indexes and 47 tertiary indexes.4.The return rate of the two rounds of Delphi experts’ questionnaires was 91.7% and 100% respectively;12(54.5%)and 9(40.9%)experts put forward their opinions and suggestions for revision in the two rounds of correspondence respectively.The expert authority coefficients(Cr)for the two rounds were 0.93 and 0.94,respectively.The Kendall coefficients for the two rounds of expert consultation were 0.209 and 0.241(P<0.001);the Kendall coordination coefficients for the first,second,and third level indicators were 0.145,0.243,and 0.215(P<0.05);and the Kendall coordination coefficients for the second round of first,second,and third level indicators were 0.139,0.257,and 0.241(P<0.05);the mean((?))significance of all indicators was≥3.5,the coefficient of variation(CV)was≤0.25,and the perfect score ratio(K)was>20%.The finalized STEMI full process nursing-sensitive quality indicators system based on the regional cooperative rescue model consists of three dimensions: structural indicators,process indicators and outcome indicators,including 3 primary indexes,12 secondary indexes and 43 tertiary indexes(including 16 structural indicators,14 process indicators and 13 outcome indicators).5.The results of the indicator weights showed that the weights of the primary indicators were structural(0.3393),process(0.3365),and outcome indicators(0.3242).The indicators with the highest weight for the secondary indicators were pre-hospital emergency(0.1683)and in-hospital cooperation(0.1683).The top three tertiary indicators were nursing charge team(0.0692),patient satisfaction(0.0637),and on-time follow-up rate(0.0606).ConclusionIn this study,we constructed a nursing-sensitive quality indicators system for the full process of STEMI based on the regional cooperative rescue model,including 3 primary indicators,12 secondary indicators,and43 tertiary indicators.The index system closely fits the regional cooperative rescue model of the current chest pain center and makes up for the shortcomings of previous studies that only focus on in-hospital emergency care.The tertiary indicators describe in detail the names,meanings and calculation methods of the indexes,making the index system practical,scientific,process-oriented and standardized.The STEMI full process nursing-sensitive quality indicators system based on the regional cooperative rescue model can provide both guidelines for clinical front-line nursing workers in the treatment of STEMI patients and reference basis and tools for clinical nursing managers to evaluate nursing quality.