消除剖腹产产后母亲常规血液检查:一个质量改进项目
概括
在剖腹产产后进行常规的产后全血细胞计 (CBC) 检测,通过实施有针对性的排序标准,可显著减少. 这项质量改善计划降低了CBC抽取量,但没有影响严重贫血检测,导致实验室利用率的持续变化.
科学领域:
- 产科和妇科 产科和妇科
- 实验室医学 实验室医学
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 常规的实验室检测,如剖腹产产后母亲的全血细胞计 (CBC),有助于医疗保健的低效和浪费.
- 目前的做法往往涉及不必要的产后CBC测试,这对大多数患者来说不会改变临床管理.
研究的目的:
- 为了减少剖腹产后的常规产后CBC检测.
- 根据严重贫血的风险因素,实施产后CBC的有针对性的排序标准.
主要方法:
- 使用两个计划-做-研究-行动 (PDSA) 周期的质量改善干预措施在一家三级医院实施.
- 电子订单集得到了修改,并为CBC订单制定了具体的标准 (血红蛋白水平,血液损失,操作时间).
- 测量的主要结果是产后CBC抽取的比例,使用运行图表进行评估.
主要成果:
- 在干预期间,产后CBC抽取比例从99%降至34% (n=202).
- 这种减少在干预后一年保持稳定.
- 严重贫血的检测率 (≤70 g/L) 没有变化 (2.4%对2.3%,p=0.88),在符合标准但没有CBC抽取的患者中没有报告贫血相关症状.
结论:
- 质量改进干预成功地实现了产后CBC订单的显著和持续减少.
- 有针对性的订购标准可以有效地减少低价值的实验室测试,而不会影响严重贫血的识别.
- 医院应该考虑通过修改订购标准来适应当地临床趋势和需求来适应类似的举措.
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