医生提醒患者在住院时预防症状性静脉血栓栓塞
Gregory Piazza1, Erin J Rosenbaum, William Pendergast
1Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. gpiazza@partners.org
Circulation
|April 15, 2009
概括
医院工作人员向医生发出警报,以改善静脉血栓塞栓症 (VTE) 预防在高风险患者中的使用. 虽然VTE率下降,但这种减少在统计学上并不显著,这表明使用率持续下降.
科学领域:
- 临床医学 临床医学
- 改善医疗保健质量 改善医疗保健质量
- 患者安全 患者安全
背景情况:
- 静脉血栓塞栓症 (VTE) 预防在住院患者中未得到充分利用.
- 一个经过验证的积分系统确定了不接受预防的高风险患者.
研究的目的:
- 评估工作人员向医生发出警报是否能减少高风险住院患者的症状性静脉瘤.
- 评估直接医生通知对VTE预防率的影响.
主要方法:
- 一个大型的多中心随机对照试验,涉及2493名患者.
- 干预组:医生被工作人员提醒;对照组:没有警报.
- 主要终点:症状,在90天内客观证实VTE.
主要成果:
- 医生警告显著增加了VTE预防的使用率 (46.0%对20.6%;P<0.0001).
- 警报组的症状VTE发病率较低 (2.7%对3.4%),但在统计学上并不显著 (HR 0.79;95%CI 0.50-1.25).
- 在各组之间,主要出血率是相似的 (2.1%对2.3%;P=0.68).
结论:
- 工作人员向医生通知有助于提高预防效果,并减少症状性静脉瘤.
- 尽管有所改善,但VTE预防仍未得到充分利用,特别是在医疗服务患者中.
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