在一个安全网设置下,在11家医院减少低价值的ED凝结症
Talia R Walker1, Risa E Bochner2, Daniel Alaiev3
1NYC Health + Hospitals/Lincoln, Department of Emergency Medicine, 234 E 149th Street, Bronx, NY 10451, United States of America.
The American journal of emergency medicine
|August 26, 2023
概括
实施最佳实践建议书 (BPA) 显著减少了急诊室中对前列血/国际规范化比率 (PT/INR) 和激活部分血栓形成时间 (aPTT) 测试的订单. 这一单一的干预措施在一个大型安全网医院系统中被证明是有效的.
科学领域:
- 临床医学 临床医学
- 医疗保健服务研究 医疗服务研究
- 提高质量 提高质量
背景情况:
- 输血红素/国际正常化比率 (PT/INR) 和激活部分血栓形成时间 (aPTT) 经常在急诊室 (ED) 订购,但往往缺乏临床实用性.
- 之前的质量改善举措已经减少了在资源充足的环境中使用PT/INR和aPTT,但在使用单一干预措施的安全网设置中没有取得成功.
研究的目的:
- 评估最佳实践咨询 (BPA) 干预措施对PT/INR和aPTT测试在大型安全网医院系统中的使用的影响.
- 确定单一干预是否可以有效地减少ED中低价值实验室测试.
主要方法:
- 在美国大型安全网系统中的11家急症医院进行了一项准实验性研究.
- 两种BPA可以阻止不适当的PT/INR和aPTT使用,这些药物在一段时间内被实施.
- 间断时间序列回归分析比较了干预前后的测试订单率 (PT/INR,aPTT和CBC作为对照).
主要成果:
- PT/INR测试订单下降了18.9% (4.11个测试/100个ED遭遇) 和aPTT下降了19.8% (4.03个测试/100个ED遭遇).
- 干预导致PT/INR的直接下降率为25.7%,aPTT的下降率为24.7%.
- 个别医院的减少有所不同,但对照 (CBC) 和斜率差异没有显著变化.
结论:
- 在一个大型安全网系统中,BPA干预有效地减少了在紧急部门使用PT/INR和aPTT测试的使用.
- 这项研究表明,在资源有限的环境中,使用单一干预措施来减少低价值实验室测试的可行性.
- 建议进行进一步的研究,以评估这种干预措施的可扩展性和通用性,以非安全网医院.
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