Douglas P, Asimus M, Swan J, Spigelman A
Maitland District Hospital, Maitland, New South Wales, Australia.
J Qual Clin Pract. 2001 Dec;21(4):149-53. doi: 10.1046/j.1440-1762.2001.00435.x.
Using clinical practice improvement methodology, a project was undertaken to reduce the incidence of surgical wound infections following elective hip and knee replacement surgery. A team was established, key measures for improvement were identified, strategies for change were developed and an action plan was implemented. Outcomes for this project included a reduction in the rate of clean surgical wound infection for joint replacement surgery from 28% to zero. Average length of stay for total hip replacement surgery was reduced from 13.9 to 9.3 days and from 14.6 to 10.4 days for total knee replacement surgery. Guidelines for patient selection were developed along with a protocol for the management of preparation to prevent urinary tract infections. Post-discharge surveillance and a preoperative rehabilitation and exercise programme have been implemented. There is potential for wider uptake and implementation of the quality principles described herein.
运用临床实践改进方法，开展了一个项目，以降低择期髋关节和膝关节置换手术后手术伤口感染的发生率。成立了一个团队，确定了关键的改进措施，制定了变革策略并实施了行动计划。该项目的成果包括关节置换手术清洁手术伤口感染率从28%降至零。全髋关节置换手术的平均住院时间从13.9天降至9.3天，全膝关节置换手术的平均住院时间从14.6天降至10.4天。制定了患者选择指南以及预防尿路感染的准备管理方案。实施了出院后监测以及术前康复和锻炼计划。本文所述的质量原则有更广泛采用和实施的潜力。
