通过基于电子健康记录的干预来改善对肝素诱导的血小板缺血检测的审慎使用
Joint Commission journal on quality and patient safety
|July 21, 2023
概括
一个临床决策支持 (CDS) 工具将4Ts得分集成到电子健康记录 (EHR) 中,显著减少了氨酸诱导的血小板缩抗体 (HAb) 测试订单. 这种干预有助于减少临床实践中不必要的HAb测试.
科学领域:
- 临床信息学 临床信息学
- 血液学 血液学 血液学
- 药物监督 药物监督 药物监督
背景情况:
- 肝素诱导的血小板缺血 (HIT) 是一种严重的免疫中介反应,导致血栓栓塞.
- 目前针对HIT抗体 (HAb) 的查试验具有较低的特异性,导致高的假阳性率.
- 4Ts评分是一个验证的工具来评估HIT的预测概率.
研究的目的:
- 评估基于电子健康记录 (EHR) 的临床决策支持 (CDS) 工具,包括4Ts得分对HAb订单量的影响.
- 确定CDS工具是否可以减少不必要的HAb测试.
主要方法:
- 一项回顾性研究比较了在EHR中CDS工具实施之前和之后的HAb测试订单.
- 研究期间包括一个预干预阶段 (2019年1月至10月) 和一个干预后阶段 (2019年11月至2021年10月).
- 主要结果是平均每月的HAb订单;次要结果包括订单发病率和订购的测试比例,其中4Ts得分较低.
主要成果:
- 平均每月的HAb订单从干预前的61.6下降到干预后的50.5 (p=0.003).
- HAb订单发病率从9.2下降到每1000例患者接触中的8.0 (p=0.002).
- 在干预后的时期,20.7%的HAb订单的4Ts得分很低,这表明可能会进行不必要的测试.
结论:
- 基于EHR的简单CDS工具的实施有效地降低了HAb订单的速度.
- 该CDS工具显示了减少不必要的HAB测试,改善诊断管理的潜力.
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