实施共识驱动的质量改进协议,以减少选择性动脉内切除术后的逗留时间
Zach M Feldman1, Srihari K Lella1, Sujin Lee1
1Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Annals of vascular surgery
|June 24, 2023
概括
一个质量改进方案减少了40%的慢动脉内关节切除术 (CEA) 后延长停留时间 (LOS) 的患者的百分比. 这一倡议的重点是管理术后高血压和尿路保留,以改善患者的治疗结果.
科学领域:
- 血管外科 血管外科
- 提高质量 提高科学 提高质量
- 医疗保健服务研究 医疗服务研究
背景情况:
- 国家指导方针建议选择性动脉内关节切除术 (CEA) 的术后停留时间 (LOS) 为1天.
- 术后护理协调的差距可能会阻碍实现这一目标.
- 尿和术后高血压被确定为增加该机构CEA LOS的关键因素.
研究的目的:
- 设计和实施质量改进 (QI) 协议,以减少手术后的LOS.
- 为了解决尿和术后高血压导致长期LOS的具体问题.
- 改善机构在实现CEA的1天LOS目标方面的表现.
主要方法:
- 使用两个计划-做-研究-行动 (PDSA) 周期实施了QI协议.
- 该协议标准化了手术前和术后第一天的抗高血压药物管理.
- 对所有男性患者进行了手术前的阿尔法-1 阻塞.
主要成果:
- 患有LOS>1天的患者的百分比从58.3%降至32.8% (P=0.01).
- 对抗高血压药物治疗方案的坚持率为89.8%,而手术前α-1阻塞的坚持率为78.8%.
- 在干预前和干预后的队列之间,30天再入院率没有显著差异.
结论:
- 一个基于共识的QI协议显著提高了CEA后1天术后LOS的实现率.
- 该方案在主要结果测量中显示了~40%的改善.
- 未来减少CEA LOS的努力应优先考虑尽量减少术后高血压和尿液保留.
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