实施急性胃肠道出血多学科诊疗方案后预后改善。
Improved outcomes following implementation of an acute gastrointestinal bleeding multidisciplinary protocol.
作者信息
Loftus Tyler J, Go Kristina L, Hughes Steven J, Croft Chasen A, Smith Robert Stephen, Efron Philip A, Moore Frederick A, Brakenridge Scott C, Mohr Alicia M, Jordan Janeen R
机构信息
From the University of Florida Health, Department of Surgery, and Sepsis and Critical Illness Research Center, Gainesville, Florida.
出版信息
J Trauma Acute Care Surg. 2017 Jul;83(1):41-46. doi: 10.1097/TA.0000000000001295.
BACKGROUND
Effective multidisciplinary management of gastrointestinal bleeding (GIB) requires effective communication. We instituted a protocol to standardize communication practices with the hypothesis that outcomes would improve following protocol initiation.
METHODS
We performed a retrospective cohort analysis of 442 patients who required procedural management of acute GIB at our institution during a 50-month period spanning 25 months before and 25 months after implementation of a multidisciplinary communication protocol. The protocol stipulates that when a patient with severe GIB is identified, a conference call is coordinated among the gastroenterology, interventional radiology, and acute care surgery teams. A consensus plan is generated and then reassessed following procedural interventions and changes in patients' status. Patients' characteristics, management strategies, and outcomes were compared before and after protocol initiation.
RESULTS
Patient populations before and after protocol initiation were similar in age, comorbidities, outpatient use of antiplatelet/anticoagulant medications, admission vital signs, and admission laboratory values. The median interval between admission and the first procedure was significantly shorter in the protocol group (40 vs 47 hours, p = 0.046). The proportion of patients who received packed red blood cell transfusions decreased following protocol initiation (41% vs 50%, p = 0.018). Median hospital length of stay was significantly shorter in the protocol group (5.0 vs 6.0 days, p = 0.014). Readmissions with GIB were decreased after protocol implementation (8% vs. 15%, p = 0.023).
CONCLUSION
Implementation of a multidisciplinary protocol for management of acute GIB was associated with earlier intervention, fewer packed red blood cell transfusions, shorter hospital length of stay, and fewer readmissions with GIB. Future research should seek to establish causal relationships between communication practices and outcomes.
LEVEL OF EVIDENCE
Therapeutic study, level III.
背景
有效的多学科管理胃肠道出血（GIB）需要有效的沟通。我们制定了一项协议来规范沟通实践，假设在协议启动后结果会得到改善。
方法
我们对442例在我们机构接受急性GIB程序管理的患者进行了回顾性队列分析，该时间段为实施多学科沟通协议之前的25个月和之后的25个月，共50个月。该协议规定，当识别出严重GIB患者时，胃肠病学、介入放射学和急性护理手术团队之间要进行电话会议。制定一个共识计划，然后在程序干预和患者状态变化后重新评估。比较协议启动前后患者的特征、管理策略和结果。
结果
协议启动前后的患者群体在年龄、合并症、门诊使用抗血小板/抗凝药物、入院生命体征和入院实验室值方面相似。协议组入院与首次手术之间的中位间隔时间明显更短（40小时对47小时，p = 0.046）。协议启动后接受浓缩红细胞输血的患者比例下降（41%对50%，p = 0.018）。协议组的中位住院时间明显更短（5.0天对6.0天，p = 0.014）。协议实施后GIB再入院率降低（8%对15%，p = 0.023）。
结论
实施急性GIB多学科管理协议与更早的干预、更少的浓缩红细胞输血、更短的住院时间以及更少的GIB再入院相关。未来的研究应寻求建立沟通实践与结果之间的因果关系。
证据水平
治疗性研究，III级。
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