在重症监护中审计血输血:使用决策时间间隔分析
Walter H Dzik1, Kristen Ruby1, Patricia A R Brunker1
1Blood Transfusion Service, Massachusetts General Hospital, MGB Healthcare, Boston, MA, US.
American journal of clinical pathology
|April 18, 2024
概括
使用决策时间间隔 (DTI) 的新方法揭示了鲜明的输血模式. 与传统的血液审计数据分析相比,这种方法可以更清楚地了解临床实践.
科学领域:
- 输血医学 输血医学
- 医疗保健分析 医疗保健分析
- 临床实践评估 临床实践评估
背景情况:
- 传统的血液利用审计可能无法完全捕捉临床决策细微差别.
- 了解输血实践需要对患者护理事件进行详细分析.
- 现有的方法可能会掩盖输血或不输血血液制品的模式.
研究的目的:
- 引入一种用于可视化血液利用数据的新方法.
- 利用决策时间间隔 (DTI) 进行增强的数据分析.
- 为了比较基于DTI的数据显示与传统的审计方法.
主要方法:
- 一个学术医院的重症监护病房 (ICU) 患者数据的回顾性分析 (2018年1月 - 2023年6月).
- 将患者护理事件划分为连续的决策时间间隔 (DTI).
- 在每个DTI内记录和分析输血血液产品,与国际规范化比率 (INR) 值相关联.
主要成果:
- 分析了16562名患者,6980个血单位和21034个红细胞单位的111,557个DTI.
- 血输血发生在1.5%的INR≤1.5的病例和2.2%的INR<2.0的病例中.
- 在只有0.75%的DTI中,没有红细胞输血的血;在三个ICU中观察到输血实践的显著差异.
结论:
- 决策时间间隔 (DTI) 分析为输血和非输血决策提供了洞察力.
- 基于DTI的利用审查揭示了与传统审计显示不同的临床实践模式.
- 这种方法为在重症监护机构使用血液制品提供了更全面的了解.
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