一项质量改善倡议,以减少重复的炎症标记物使用
Kathryn E Bakkum1, Kathy H Stoner2, David A Gannon3
1From the Division of Hospital Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio.
Pediatric quality & safety
|September 20, 2024
概括
这项质量改进项目成功地将儿科患者的重复炎症标记 (IM) 测试减少了30%以上. 该研究表明,减少IM使用是可行的,而不会对患者的治疗结果产生负面影响.
科学领域:
- 临床医学 临床医学
- 提高质量 提高科学 提高质量
- 儿科医院医药 儿科医院医药
背景情况:
- 多个炎症标志物 (IMs) 经常一起订购,尽管缺乏支持临床益处的证据.
- 不必要的实验室检测增加了医疗保健成本,并可能导致患者受到伤害.
研究的目的:
- 在12个月内将儿童患者订购的重复炎症标记测试数量减少10%.
- 评估质量改进倡议对IM订单实践的影响.
主要方法:
- 一个使用改善方法模型的质量改进项目在儿科医院医疗服务中实施.
- 干预措施包括提供者教育,整合到医生激励计划中,以及对疾病特定途径的审查.
- 主要结果:减少"双重IM使用" (24小时内≥2次IM);次要结果:减少任何IM使用;平衡措施:使用全血细胞计数,停留时间,再接收率.
主要成果:
- 基线双重IM使用率为43%,干预后降至12%.
- 整体IM使用率从19%降至12%.
- 包括停留时间和再接收率在内的平衡措施保持稳定,全血细胞计使用没有明显的相关性.
结论:
- 质量改进项目有效减少了儿科住院患者的重复和整体炎症标志物测试.
- 这些减少在没有对关键患者安全和护理指标产生不良影响的情况下实现.
- 在儿科医院设置中,可以实现炎症标志物测试的安全降级.
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