Tarrant Madelaine, Honeyman Calum, Aquilina Alex, Young Katie
North Bristol NHS Trust.
BMJ Qual Improv Rep. 2014 Apr 4;3(1). doi: 10.1136/bmjquality.u202211.w1101. eCollection 2014.
Medicine is becoming increasingly protocol driven. This provides a standardised format for doctors to deliver best practice, especially in the acute setting. 40 junior doctors were asked to locate three Trust guidelines: venous thromboembolism (VTE) prophylaxis; antibiotic prescribing; and management of upper gastrointestinal bleed (UGIB). For each doctor the time taken and number of mouse clicks to access each guideline was recorded. Following successful redesign of the Trust intranet we completed a re-audit. Initial results showed 48% of doctors were unable to locate the UGIB or the VTE guidelines within 5 min. For those who were able to locate the guidelines it took an average of 111 sec and 17 mouse clicks. 100% of doctors were able to locate the antibiotic guidelines in 12 sec and with two clicks. These are accessible via a single port of access. Following our redesign of the Trust intranet 100% of doctors located all three guidelines in an average time of 7.2 sec and in 2.1 clicks. Improvement in access to VTE prophylaxis and UGIB was statistically significant (p=0.001). Redesigning our Trust intranet homepage has significantly improved the accessibility of acute surgical and medical guidelines.
医学越来越受协议驱动。这为医生提供了一种标准化的格式来提供最佳实践，尤其是在急性情况下。40名初级医生被要求查找三项信托指南：静脉血栓栓塞（VTE）预防；抗生素处方；以及上消化道出血（UGIB）的管理。记录了每位医生查找每项指南所花费的时间和鼠标点击次数。在成功重新设计信托内联网后，我们完成了重新审核。初步结果显示，48%的医生在5分钟内无法找到UGIB或VTE指南。对于那些能够找到指南的医生来说，平均需要111秒和17次鼠标点击。100%的医生能够在12秒内通过两次点击找到抗生素指南。这些可通过单一访问端口获取。在我们重新设计信托内联网后，100%的医生平均在7.2秒内通过2.1次点击找到了所有三项指南。VTE预防和UGIB的获取改善具有统计学意义（p=0.001）。重新设计我们信托内联网主页显著提高了急性外科和医学指南的可访问性。
