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实施年度住院患者血液制品使用同意书后工作效率提高了90%以上。

Work efficiency improvement of >90% after implementation of an annual inpatient blood products administration consent form.

作者信息

Lindsay Holly, Bhar Saleh, Bonifant Challice, Sartain Sarah, Whittle Sarah B, Lee-Kim Youngna, Shah Mona D

机构信息

Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Baylor College of Medicine, Houston, Texas, USA.

Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.

出版信息

BMJ Open Qual. 2018 Jan 9;7(1):e000164. doi: 10.1136/bmjoq-2017-000164. eCollection 2018.

Abstract

Paediatric haematology, oncology and bone marrow transplant (BMT) patients frequently require transfusion of blood products. Our institution required a new transfusion consent be obtained every admission. The objectives of this project were to: revise inpatient blood products consent form to be valid for 1 year, decrease provider time spent consenting from 15 to <5 min per admission, and improve provider frustration with the consent process. Over 6 months, we determined the average number of hospitalisations requiring transfusions in a random sampling of haematology/oncology/BMT inpatients. We surveyed nurses and providers regarding frustration levels and contact required regarding consents. Four and 12 months after implementation of the annual consent, providers and nurses were resurveyed, and new inpatient cohorts were assessed. Comparison of preintervention and postintervention time data allowed calculation of provider time reduction, a surrogate measure of improved work efficiency. Prior to the annual consent, >33 hours were spent over 6 months obtaining consent on 40 patients, with >19 hours spent obtaining consent when no transfusions were administered during admission. Twelve months after annual consent implementation, 97.5% (39/40) of analysed patients had a completed annual blood products transfusion consent and provider work efficiency had improved by 94.6% (>30 hours). Although several surveyed variables improved following annual consent implementation, provider frustration with consent process remained 6 out of a max score of 10, the same level as prior to the intervention. Development of an annual inpatient blood products consent form decreased provider time from 15 to <1 min per admission, decreased consenting numbers and increased work efficiency by >90%.

摘要

儿科血液学、肿瘤学和骨髓移植(BMT)患者经常需要输注血液制品。我们机构要求每次入院时都要获取一份新的输血同意书。本项目的目标是:将住院患者血液制品同意书修订为有效期为1年,将每次入院时医生获取同意书所花费的时间从15分钟减少至<5分钟,并改善医生对同意书流程的不满情绪。在6个月的时间里,我们在血液学/肿瘤学/BMT住院患者的随机抽样中确定了需要输血的平均住院次数。我们就不满程度和同意书所需的沟通情况对护士和医生进行了调查。在实施年度同意书后的4个月和12个月,对医生和护士进行了重新调查,并对新的住院患者队列进行了评估。通过比较干预前和干预后的时间数据,可以计算出医生时间的减少量,这是工作效率提高的一个替代指标。在年度同意书实施之前,在6个月的时间里,为40名患者获取同意书花费了超过33小时,其中在入院期间未进行输血时获取同意书花费了超过19小时。年度同意书实施12个月后,97.5%(39/40)的分析患者拥有完整的年度血液制品输血同意书,医生的工作效率提高了94.6%(>30小时)。尽管在实施年度同意书后,几个被调查变量有所改善,但医生对同意书流程的不满程度在满分10分中仍为6分,与干预前的水平相同。制定年度住院患者血液制品同意书使每次入院时医生的时间从15分钟减少至<1分钟,减少了同意书的数量,并提高了>90%的工作效率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1ed1/5759742/676b67c3275e/bmjoq-2017-000164f01.jpg

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