开发和实施基于临床决策支持系统的质量倡议,以减少中枢线相关的血液感染
Michelle C Spiegel1, Andrew J Goodwin1
1Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Journal of clinical and translational science
|September 30, 2024
概括
实施临床决策支持系统 (CDSS) 减少了不必要的中央静脉线 (CVL) 和中央线相关的血液感染 (CLABSI). 这有助于及时切除心血管,并提高了重症监护室 (ICU) 患者的安全.
科学领域:
- 改善医疗保健质量 改善医疗保健质量
- 预防和控制感染.
- 临床信息学是一种临床信息学.
背景情况:
- 中枢静脉线 (CVLs) 在重症监护中至关重要,但可能会导致中枢静脉线相关的血液感染 (CLABSI).
- CLABSI导致死亡率增加,住院时间延长,医疗费用增加.
- 不必要使用CVL是CLABSI发病率的重要原因之一.
研究的目的:
- 实施基于电子健康记录 (EHR) 的临床决策支持系统 (CDSS).
- 量化重症监护室 (ICU) 中可能不必要的CVL的患病率.
- 改善及时清除不必要的CVL并减少CLABSI.
主要方法:
- 开发并实施基于EHR的CDSS以识别可能不必要的CVL.
- 包括临床医生教育,审计/反机制和数据审查流程.
- 使用统计过程控制图表,奇方位分析和发病率比率来评估数据.
主要成果:
- 在实施前,25.2%的CVL可能是不必要的;只有20.0%在24小时内被删除.
- 实施后,及时清除不必要的CVL增加到29% (p < 0.0001),CVL利用率下降,CLABSI之间的日数增加.
- 这项干预措施在有肺部/重症监护医生的重症监护病房 (ICU) 显示出最大的有效性,及时移除率从18.0%增加到30.5% (p < 0.0001).
结论:
- 很大一部分中央静脉线被认为可能是不必要的.
- CDSS的实施,加上审计和反,显著增加了及时删除CVL的时间.
- 该倡议导致及时清除CVL的持续增加,并减少了CLABSI.
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