减少红细胞沉积率的排序:取消实施和诊断管理
Yasaman Fatemi1,2,3, Tracey Polsky4,5, Julianne Burns2,3
1Division of Infectious Diseases.
Hospital pediatrics
|July 11, 2024
概括
通过提供者教育和电子健康记录干预,在儿科住院和急诊环境中,例行红细胞沉积率 (ESR) 测试显著降低. 这一举措成功地减少了ESR订单,而没有增加C反应蛋白 (CRP) 测试.
科学领域:
- 临床实验室科学 临床实验室科学
- 改善医疗保健质量 改善医疗保健质量
- 儿科医学 儿科医学
背景情况:
- "明智选择"运动建议不要使用常规的红细胞沉率 (ESR) 来评估急性炎症/感染.
- 一家儿童医院观察到ESR和C反应蛋白 (CRP) 的高并发排序.
- 发起了一项倡议,在六个月内将ESR测试率降低20%.
研究的目的:
- 减少在儿科住院和急诊室使用红细胞沉积率 (ESR) 测试.
- 评估精益流程改进,提供者教育和临床决策支持在修改实验室订单实践中的有效性.
主要方法:
- 应用了精益原则来确定ESR排序的根本原因.
- 干预措施包括提供者教育和电子健康记录订单小组的实施.
- 每月ESR测试率每1000个患者日/ED访问被跟踪使用统计过程控制.
主要成果:
- 美国的ESR测试率下降了22% (住院患者) 和40% (急诊室).
- 这些减少持续了一年多,包括在COVID-19大流行期间.
- 对C反应蛋白 (CRP) 的测试率保持稳定,这表明诊断策略发生了转变,而不是减少了测试.
结论:
- 提供者教育和临床决策支持有效地减少了不必要的红细胞沉率 (ESR).
- 这些干预措施对儿科护理机构的实验室利用产生了持续的影响.
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