Mozes B, Lubin D, Modan B, Ben-Bassat I, Gitel S N, Halkin H
Department of Medicine, Chaim Sheba Medical Center, Ramat-Gan, Israel.
Arch Intern Med. 1989 Aug;149(8):1836-8.
A multiphase intervention trial based on education, implementation of criteria, and restriction, aimed at modifying the established clinical policy of mandatory preoperative screening for coagulation abnormalities, was carried out on five surgical wards of a general hospital. The education period did not influence the ordering of partial thromboplastin time tests, despite a significant posteducational change in surgeons' attitudes. In contrast, administrative restriction of coagulation test orders led to a 50% decline on four of the five study wards. We conclude that an educational intervention followed by administrative restriction may be considered an acceptable means of overcoming clinician reluctance to change well-established but redundant clinical policy.
在一家综合医院的五个外科病房开展了一项多阶段干预试验，该试验基于教育、标准实施和限制措施，旨在改变既定的术前常规筛查凝血异常的临床政策。尽管外科医生的态度在教育后有显著变化，但教育阶段并未影响部分凝血活酶时间检测的医嘱开具。相比之下，对凝血检测医嘱的行政限制导致五个研究病房中的四个病房的检测量下降了50%。我们得出结论，先进行教育干预，然后实施行政限制，可能是克服临床医生不愿改变既定但冗余的临床政策的一种可接受的方法。
