在心脏外科手术中实施动脉血液气体指示算法
Megan B Wanzer1, Tracey Wilson2, Suzanna Fitzpatrick1
1University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, United States.
概括
实施动脉血液气体 (ABG) 测试算法减少了心脏手术重症监护室中不必要的程序. 这项质量改善计划降低了成本,并通过确保ABGs在临床上有指示来改善患者护理.
科学领域:
- 关键护理医学 关键护理医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 动脉血液气体 (ABG) 在重症监护室住院期间代表着相当大的成本,非指示的测试增加了费用和患者的风险.
- 心脏外科重症监护室 (CSICU) 被确定为机构ABG利用的主要贡献者,原因是订购实践与指导方针不一致.
研究的目的:
- 在CSICU中实施基于证据的算法,用于在CSICU中标准化ABG的临床指示.
- 减少非临床指示的ABG分析和相关的医疗保健成本和患者结果的数量.
主要方法:
- 开发了一种基于氧化,通风,酸平衡,血液动力学和与体外膜氧化 (ECMO) 值相关的急性变化的算法.
- 消除了监测的常规ABG,并培训了员工如何使用非侵入性监测 (例如脉冲氧计,头像学).
- 在14周的时间内,每周进行审计,以评估合规性和指示性.
主要成果:
- 获得的ABG总量减少了8.8%,每天患者的ABG减少了32%.
- 针对ABGs的主要症状是ECMO相关性,术后状态和急性氧化/通风变化.
- 只有7.8%的ABG在实施后被发现是不适用的.
结论:
- 实施ABG指示算法成功地减少了进行测试的数量,主要是通过减少常规监测.
- 针对急性临床问题,ABG更频繁地被订购,这表明适当性有所改善.
- 实践的变化被证明是安全的,可行的,并能够为该机构带来巨大的成本节约.
相关概念视频
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