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质量报告:手术后指导方针的实施减少了Fontan手术后逗留时间

Virginia Cox¹, Stephen Hart¹, Diane Hersey¹

¹From The Heart Center at Nationwide Children's Hospital, Columbus, Ohio.

Pediatric quality & safety

|April 4, 2024

概括

实施新的临床指南显著减少了Fontan手术患者住院时间. 这种对Fontan手术患者护理的改善并没有增加再入院率.

科学领域:

心血管外科心血管外科
儿童心脏病学儿童心脏病学
质量改善倡议质量改善倡议

背景情况:

接受Fontan手术的患者往往会经历长时间的肺流,导致长时间住院.
这些患者的平均住院时间 (LOS) 超过了胸部外科医生协会的基准.
为了解决这个问题,启动了一项质量改进项目.

研究的目的:

减少Fontan手术后患者住院时间 (LOS).
到2021年1月1日,将平均LOS从基线23天降至7天.
为了无限期地维持这种减少的LOS.

主要方法:

标准化术后临床实践指南于2020年4月实施.
关键干预措施包括门诊PleurX排水,带有液体限制的尿液和肺血管扩张疗法.
患者在内置的PleurX排水的情况下出院.

主要成果:

芬坦手术患者的平均医院LOS从实施前23天减少到2020年的8天和实施后的7天.
总共有107名患者在指导方针之前和35名指导方针后被分析.
在30天的再接收率中没有显著差异 (24%前比23%后;P = 0.86).

结论:

标准化临床实践指南的实施有效地减少了Fontan手术患者的医院LOS.
新的指导方针实现了超过50%的医院LOS减少.
观察到的LOS减少是没有增加30天再入院的结果.

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