Thompson Sarah, Jones Rhian
Northumbria Healthcare Trust, UK.
BMJ Qual Improv Rep. 2016 May 10;5(1). doi: 10.1136/bmjquality.u209241.w3796. eCollection 2016.
There are several investigations that can be completed in the acute phase of admission for patients with suspected stroke.These include receiving a CT Head scan and also blood tests specific for stroke. The national guidelines regarding CT Head scans detail they should be completed within 12 hours of admission(1) and the trust guidelines, local to where this quality improvement project was based, advise a CT Head should be completed within four hours of admission.(2) The current national guidelines do not specify exact stroke blood tests, however trust guidelines give a specific set of blood tests that would be appropriate to be taken when a patient presents to A&E with a suspected stroke. These included FBC, U&E, blood glucose, ESR, cholesterol, TFTs, and coagulation screen.(2) The aim of this quality improvement project was to assess the timing of CT Head scans and blood tests and to implement a tool to ensure these are done in a timely fashion, within the emergency care setting. The project was completed through three PSDA cycles. The first was undertaken in an A&E department, which was soon to be closed and moved to a different site. The second cycle was then completed at the new site, to assess if there had been any change in timings of these interventions. In the previous site it was found that 97% of patients audited received a CT Head scan within four hours. At the new site it was found 94% patients received a CT Head within four hours, therefore both meeting trust targets on the whole. A full set of stroke blood tests were completed at the old site in 53% of patients and this decreased to 22% of patients at the new site. At this point it was decided an intervention should be implemented to ensure this did not continue. The intervention used was updating a stroke panel on the trust computer system (an easy to use, one-click button entitled "Stroke/TIA") with the correct blood tests and the use of this was promoted throughout the trust. A post-intervention audit was completed three months after the tool was promoted and patients receiving the correct blood tests whilst in the A&E department increased to 75%. The amount of patients receiving a CT Head scan within four hours was 100% therefore meeting both trust and national guidelines. In conclusion, the stroke blood panel appears to have improved the amount of patients receiving the correct blood tests when admitted with suspected stroke and will continue to stay in place at the trust.
对于疑似中风患者，在入院急性期可完成多项检查。这些检查包括进行头部CT扫描以及针对中风的特定血液检查。关于头部CT扫描的国家指南详细规定应在入院后12小时内完成（1），而本质量改进项目所在地区的信托指南建议应在入院后4小时内完成头部CT扫描。（2）当前国家指南未明确具体的中风血液检查项目，然而信托指南给出了一组特定的血液检查项目，当患者因疑似中风前往急诊时进行这些检查是合适的。这些检查包括全血细胞计数、尿素和电解质、血糖、红细胞沉降率、胆固醇、甲状腺功能检查以及凝血筛查。（2）本质量改进项目的目的是评估头部CT扫描和血液检查的时间安排，并实施一种工具以确保在急诊护理环境中及时完成这些检查。该项目通过三个计划 - 实施 - 检查 - 行动（PSDA）循环完成。第一个循环在一个即将关闭并迁至不同地点的急诊科进行。第二个循环随后在新地点完成，以评估这些干预措施的时间安排是否有任何变化。在前一个地点，发现接受审核的患者中有97%在4小时内接受了头部CT扫描。在新地点，发现94%的患者在4小时内接受了头部CT扫描，因此总体上都达到了信托目标。在旧地点，53%的患者完成了全套中风血液检查，而在新地点这一比例降至22%。此时决定应实施一项干预措施以确保这种情况不再持续。所采用的干预措施是在信托计算机系统上更新中风检查项目（一个易于使用的一键式按钮，名为“中风/短暂性脑缺血发作”），列出正确的血液检查项目，并在整个信托机构推广其使用。在推广该工具三个月后完成了干预后审核，在急诊科接受正确血液检查的患者比例增至75%。在4小时内接受头部CT扫描的患者比例为100%，因此既达到了信托指南目标，也符合国家指南。总之，中风血液检查项目似乎提高了疑似中风入院患者接受正确血液检查的比例，并且将继续在该信托机构实施。
