Britton Daniel J, Bloch Rebecca B, Strout Tania D, Baumann Michael R
Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA.
J Emerg Med. 2013 Feb;44(2):528-35. doi: 10.1016/j.jemermed.2012.06.016. Epub 2012 Aug 24.
Care of the sexual assault patient in the Emergency Department can be challenging due to complex pharmacologic interventions, evidence-collection procedures, and concomitant injury.
We sought to determine the effect of a standard, computerized order set for the treatment of adult victims of sexual assault on compliance with current Centers for Disease Control and Prevention (CDC) guidelines for the treatment of this population.
This study utilized a pretest-post-test design to evaluate the implementation of a standardized order set that provided clinicians with treatment recommendations consistent with CDC guidelines. Comparison of the rate of compliance with CDC guidelines before (n = 322) and after (n = 131) implementation of the order set was the primary outcome. Additional analyses examined for differences in compliance based upon evaluation by a sexual assault nurse/forensic examiner (SANE/SAFE), sex, and race.
Pre-intervention phase compliance was 14 of 322 cases (4.4%) and post-intervention compliance was 108 of 131 cases (82.4%). This difference was statistically significant, χ(2) = 291.635, df = 1, p < 0.001. Overall, compliance with CDC pharmacologic recommendations was achieved in 122 (26.9%) cases. Evaluation by a SANE/SAFE nurse conferred no statistically significant difference in compliance. No statistically significant differences were noted based upon sex or race.
The implementation of a standard, computerized order set for the treatment of adult victims of sexual assault significantly improved medical provider compliance with CDC treatment guidelines. This research demonstrates that electronic order sets can promulgate evidence-based practices in clinical medicine.
由于复杂的药物干预、证据收集程序以及伴随的损伤，急诊科对性侵犯患者的护理具有挑战性。
我们试图确定用于治疗成年性侵犯受害者的标准化计算机医嘱集对遵循美国疾病控制与预防中心（CDC）当前针对该人群治疗指南的影响。
本研究采用前后测试设计，以评估标准化医嘱集的实施情况，该医嘱集为临床医生提供了与CDC指南一致的治疗建议。主要结果是比较医嘱集实施前（n = 322）和实施后（n = 131）遵循CDC指南的比率。额外分析根据性侵犯护士/法医检查官（SANE/SAFE）的评估、性别和种族来检查遵循情况的差异。
干预前阶段的遵循情况为322例中的14例（4.4%），干预后的遵循情况为131例中的108例（82.4%）。这种差异具有统计学意义，χ(2) = 291.635，自由度 = 1，p < 0.001。总体而言，122例（26.9%）实现了对CDC药物建议的遵循。由SANE/SAFE护士进行的评估在遵循情况上没有统计学上的显著差异。基于性别或种族未发现统计学上的显著差异。
实施用于治疗成年性侵犯受害者的标准化计算机医嘱集显著提高了医疗服务提供者对CDC治疗指南的遵循程度。这项研究表明电子医嘱集可以在临床医学中推广循证实践。
