改善长骨开口骨折的抗生素治疗时间:质量改善倡议
概括
改善开放骨折的抗生素管理对于预防感染至关重要. 一个新的工作流显著减少了急诊部 (ED) 抗生素的时间,从76分钟减少到40分钟.
科学领域:
- 创伤外科手术是什么
- 预防传染病 预防传染病
- 医疗保健过程改进 医疗保健过程改进
背景情况:
- 由于环境暴露,开放骨折具有很高的感染风险.
- 在急诊室 (ED) 及时 (在60分钟内) 服用抗生素对于预防感染至关重要.
- 高的ED患者数量往往会阻碍及时的抗生素输送.
研究的目的:
- 为了提高长骨开口骨折患者的抗生素给药时间.
- 为了提高在1级创伤中心的抗生素输送60分钟窗口的坚持,ED.
主要方法:
- 使用精益六西格玛定义,测量,分析,改进和控制 (DMAIC) 框架.
- 实施的干预措施包括教育举措,电子医疗记录 (EMR) 订单集和工作流程重组.
- 优先考虑长骨开口骨折,以便在重症监护区立即评估和给予抗生素.
主要成果:
- 从76到40分钟显著减少了对抗生素的平均时间 (p < .001).
- 在60分钟内接受抗生素的患者比例从64%增加到92% (p < .001).
- 没有观察到年龄,性别,损伤机制,抗生素选择或骨折位置的显著变化.
结论:
- 流程改进方法,特别是精益六西格玛,有效地减少了开放骨折的抗生素给药时间.
- 优化工作流程和有针对性的干预措施是改善高量ED设置及时护理的关键.
- 成功实施证明了可复制的模型,以提高创伤中心的重症护理服务.
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