提高胸痛的管理,使用高灵敏度的托罗邦基协议来改善胸痛的管理
Kristin Lohr1, Colleen O'Connor1, Timothy Shapiro2
1Department of Hospital Medicine, Main Line Health-Lankenau Medical Center, Wynnewood, PA.
实施高灵敏度热素测定和方案显著减少了急诊室住院时间和胸痛患者的住院时间. 这种方法还减少了不必要的心脏检测,提高了效率和患者护理.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 临床诊断 临床诊断 临床诊断
背景情况:
- 胸痛是急诊室 (ED) 的常见投诉,需要准确有效地诊断心脏病,如心肌梗塞.
- 传统的素测定在灵敏度和速度上有局限性,影响患者的情绪和诊断时间表.
- 高灵敏度热素 (hs-cTn) 测定可以在较低水平上进行更好的检测,从而有可能加速诊断和管理.
研究的目的:
- 实施和评估一项质量改善项目,用于在ED环境下管理胸痛患者.
- 评估高灵敏度的热素测定与风险预测算法相结合对患者护理和资源利用的影响.
- 解决采用障碍,优化胸痛评估工作流程.
主要方法:
- 一个社区学术卫生系统实施了一个标准化的胸痛检查协议,使用高灵敏度的热素测定和风险预测算法 (心脏,心电图,年龄,风险因子,热素评分).
- 关键利益相关者确定并解决了障碍,包括提供者战略,电子病历集成和心脏病学服务能力.
- 干预措施包括利益相关者购买,定期报告数据,团队会议和全面教育,以推动实践中的变化.
主要成果:
- 实施后的12个月期间,涉及3293名患者,显示胸痛ED平均停留时间从297分钟减少到274分钟 (P=0.03).
- 由于胸痛而入院的观察患者从23%降至14% (P<0.001),压力测试的减少 (12至3个/月),心声图 (61至46个/月),心脏病咨询 (125至81个/月) 和心脏导管治疗 (41至32个/月) 的减少.
- 在多种心脏诊断模式 (大多数P<0.001) 中,观察到测试和入院的显著减少.
结论:
- 实施标准化胸痛管理方案,使用高灵敏度热素测定和风险评分,有效减少ED停留时间和住院观察入院.
- 该协议导致不必要的心脏检测和咨询显著减少,优化了资源配置.
- 标准化协议和医生领导是改善ED胸痛管理的高影响干预措施.
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