减少不必要的资源利用新发作,未引起的,在急诊室的发烧性发作
Laura A Santry1, Kathryn Giordano1, Andrew Mower2
1From the Department of Pediatrics Division of Pediatric Emergency Medicine, Nemours Children's Health, Wilmington, Del.
Pediatric quality & safety
|January 13, 2025
概括
一个新的临床途径显著减少了儿童发作的不必要的急诊室 (ED) 资源使用. 这一举措减少了脑电图 (EEG) 测试和神经病学咨询,提高了效率并降低了成本.
科学领域:
- 儿科神经学 儿科神经学
- 紧急医疗 紧急医疗
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 儿科发作占急诊室 (ED) 访问的很大一部分.
- 目前的做法往往涉及不必要的实验室评估和新出现的电脑电图 (EEG) 对于低风险的发作.
- 需要优化ED资源的利用,用于儿科的发作表现.
研究的目的:
- 实施和评估一种临床途径,以减少ED中不必要的资源利用,用于患有新发作,未引起,无发烧的儿科患者.
- 评估该途径对EEG订购,实验室测试,神经病理咨询和患者处置时间的影响.
主要方法:
- 一个多学科的团队利用计划-做-研究-行动循环来实施一种新的临床途径.
- 关键干预措施包括标准化的订单集,ED的门诊EEG安排,以及神经病学团队的自动通知.
- 收集了EDEEGs,实验室测试,神经病理咨询,房间出院时间,医疗费用和30天反弹率的数据.
主要成果:
- 在实施阶段,ED EEGs从59%大幅下降到1%.
- 全血细胞计数和神经病学咨询也大幅下降 (分别为50%至16%和90%至31%).
- 房间到出院的时间有所改善 (308分钟到203.5分钟),每名患者初步成本节省了630美元.
结论:
- 开发的临床途径有效地减少了儿童发作的急诊室资源利用率.
- 该倡议导致患者处置时间缩短,医疗保健成本大幅降低.
- 虽然有效,但30天反弹率略有增加,因此需要继续监测.
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