紧急部门的安全,效率和成本冲突 护理点 热素测试 热素测试
Zoe Grabinski1, Jordan L Swartz, Yelan Wang
1Author Affiliations: Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine (Drs Grabinski, and Swartz, Ms Wang, and Drs Itani, Gulati, Wittman, and Smith), Department of Pathology (Dr Aguero-Rosenfeld), Clinical Laboratories (Dr Aguero-Rosenfeld and Ms Sanchez), Institute for Innovations in Medical Education, New York University Grossman School of Medicine (Dr Smith), NYU Langone Health, New York.
对于急性冠状动脉综合征 (ACS) 的治疗点位热素 (POCT-Tns) 显示不一致的准确性. 一项质量改善倡议减少了POCT-Tn的使用,降低了成本并改善了患者处置时间.
科学领域:
- 紧急医疗 紧急医疗
- 临床化学 临床化学
- 提高质量 提高科学 提高质量
背景情况:
- 在急性冠状动脉综合征 (ACS) 的快速评估中使用临床点位托罗素测试 (POCT-Tns).
- 与实验室热素 (LABT-Tn) 相比,POCT-Tns的准确性和灵敏度较低.
- 不适当地使用POCT-Tns来排除ACS可能会导致早期诊断关闭和患者风险.
研究的目的:
- 尽量减少在急诊部 (ED) 进行不加区分的POCT-Tn测试.
- 为了平衡测试周转时间 (TAT),机构成本和患者处置时间 (TTD).
- 评估教育干预和电子健康记录 (EHR) 调整对热素检测实践的影响.
主要方法:
- 一个质量改善 (QI) 倡议,从2018年到2022年实施.
- 使用了教育干预措施和EHR调整.
- 分析包括测试特征,频率,TAT,成本和TTD,使用统计过程控制图表和曼-惠特尼U/威尔科克森签名等级总和测试.
主要成果:
- 与LAB-Tn相比,POCT-Tn显示出高异调 (9.7%) 和低灵敏度 (52.5%).
- 该QI倡议显著降低了POCT-Tn测试频率.
- 总托罗邦素检测成本每年减少超过668,000美元;接受POCT-Tn与反射到LABT-Tn的患者的处置时间有所改善.
结论:
- POCT-Tn测试特征可能会导致错过ACS诊断的风险.
- 教育和EHR调整的结合方法有效地减少了无差别的POCT-Tn使用.
- 该计划成功降低了医疗保健成本,并优化了ED中的患者处置时间.
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