Venkatesh Arjun K, Hajdasz David, Rothenberg Craig, Dashevsky Meir, Parwani Vivek, Sevilla Mark, Shapiro Marc, Schwartz Ian
1 Yale University, New Haven, CT.
2 Yale New Haven Hospital, New Haven, CT.
Am J Med Qual. 2018 Jan/Feb;33(1):81-85. doi: 10.1177/1062860617691842. Epub 2017 Feb 1.
Point of care (POC) laboratory testing is used to improve emergency department (ED) throughput but often overuses resources by duplicating formal laboratory testing. This study sought to evaluate the effect of a multimodal intervention on duplicate chemistry testing. This pre-post analysis included all visits to 2 urban EDs between June 2014 and June 2016. The multimodal intervention including provider education, signage, electronic health record redesign, and audit and feedback focused on reducing duplicate chemistry testing. The primary outcome was the number of duplicate chemistry tests per 100 visits. Autoregressive integrated moving-average models were used to account for secular changes. A total of 299 701 ED visits were included. The daily number of duplicate chemistry and POC chemistry tests significantly decreased following the intervention (3.3 fewer duplicates and 10.2 fewer POC per 100 ED visits, P < .0001). This implementation of a multimodal quality improvement intervention yielded substantial reductions in the overuse of blood chemistry testing in the ED.
即时检验（POC）实验室检测旨在提高急诊科（ED）的诊疗效率，但常常因重复进行常规实验室检测而过度消耗资源。本研究旨在评估多模式干预对重复化学检测的影响。这项前后分析涵盖了2014年6月至2016年6月期间两家城市急诊科的所有就诊病例。多模式干预包括对医护人员的教育、设置标识、重新设计电子健康记录以及审核与反馈，重点在于减少重复化学检测。主要结局指标是每100次就诊中重复化学检测的次数。采用自回归积分滑动平均模型来解释长期变化。总共纳入了299701例急诊科就诊病例。干预后，每日重复化学检测和即时化学检测的次数显著减少（每100次急诊科就诊中，重复检测减少3.3次，即时检测减少10.2次，P < .0001）。这种多模式质量改进干预措施的实施，大幅减少了急诊科血液化学检测的过度使用情况。
