实施力度:通过一个关心点决策支持工具,减少不适当的心声回声图的订单
Hassan Ashraf1, Cecil A Rambarat2, Michael L Setteducato1
1Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL, United States of America.
概括
实施决策支持工具 (DST) 并没有显著减少不恰当的胸前心电回声图 (TTEs). 需要进一步的教育,因为临床医生的知识差距导致了该工具在改善TTE订单方面的无效性.
科学领域:
- 心脏病学 心脏病学
- 改善医疗质量 改善医疗质量
- 医疗信息学 医疗信息学
背景情况:
- 过胸腔心声图 (TTEs) 的不适当排序导致医疗保健成本增加和潜在的患者伤害.
- 质量改善举措对于优化诊断测试利用至关重要.
研究的目的:
- 通过一系列计划-做-研究-行动 (PDSA) 质量改进周期,减少不适当的胸前回声心图 (TTEs).
- 评估一个决策支持工具 (DST) 的有效性,该工具集成到TTE的电子订单系统中.
主要方法:
- 实施了三个PDSA周期,从通用DST开始,然后是定制的DST,最后是直接的临床医生教育.
- 分析了TTE订单的数据,以评估不适当利用的变化.
主要成果:
- 最初的DST实施没有显著减少不适当的TTEs (RR 0.71,p=0.12).
- 随后的量身定制的DST导致不适当的TTEs减少 (RR=0.69,p=0.014),但特定的目标不适当的TTEs增加.
- 临床医生的反显示了有关适当的TTE使用标准的重大知识差距.
结论:
- 单独适应特定设施的DST不足以大幅减少不适当的TTEs.
- 临床医生对TTE适当使用标准的知识缺口可能导致了DST有限的成功.
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