Close Allison G, Sequeira Gina M, Montano Gerald T, Alessi Lauren J, McCormick Meghan C, Cooper James D, Epperly Rebecca A, Zuckerbraun Noel S
Hematology/Oncology Division, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Institute of Clinical Research, University of Pittsburgh, Pittsburgh, Pennsylvania.
Institute of Clinical Research, University of Pittsburgh, Pittsburgh, Pennsylvania; Adolescent Medicine Division, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
J Pediatr Adolesc Gynecol. 2019 Apr;32(2):128-134. doi: 10.1016/j.jpag.2018.11.002. Epub 2018 Nov 17.
We sought to improve emergency care for adolescents with abnormal uterine bleeding (AUB) by developing a clinical effectiveness guideline (CEG) and assessing its effect on quality of care.
DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: A stakeholder engagement group designed a CEG algorithm for emergency AUB management. Pediatric residents received CEG training and their knowledge and attitudes were assessed using pre- and post intervention surveys. International Classification of Diseases ninth and 10th revision codes identified electronic health record data for patients who presented to the pediatric emergency department for AUB 6 months before and after CEG implementation. A weighted, 20-point scoring system consisting of prioritized aspects of history, laboratory studies, and management was developed to quantify the quality of care provided.
Descriptive statistics, χ test, Wilcoxon rank sum test, and a run chart were used for analysis.
Pediatric residents reported higher confidence and knowledge scores post CEG implementation. Of the 91 patients identified, 62 met inclusion criteria. Median score was 14 ± 7 before CEG implementation and 15.5 ± 6 after. The Wilcoxon rank sum test showed a difference in AUB evaluation and management scores (P = .09) after implementation of the CEG. Run chart data showed no shifts or trends (overall median score, 14 points). Pre- and post implementation, points were deducted most frequently for not assessing personal/family clotting disorder history. The largest improvements in care were with appropriate medication dosing and disposition.
We designed a CEG and educational intervention for AUB management in a pediatric emergency department. These findings suggest our CEG might be an effective tool to improve emergency AUB care for adolescents and could increase trainees' confidence in managing this condition, although additional cycles are needed.
我们试图通过制定临床疗效指南（CEG）并评估其对护理质量的影响，来改善青少年异常子宫出血（AUB）的急诊护理。
设计、地点、参与者和干预措施：一个利益相关者参与小组设计了用于AUB急诊管理的CEG算法。儿科住院医师接受了CEG培训，并通过干预前后的调查评估他们的知识和态度。国际疾病分类第九版和第十版编码确定了CEG实施前后6个月到儿科急诊科就诊的AUB患者的电子健康记录数据。开发了一个由病史、实验室检查和管理的优先方面组成的20分加权评分系统，以量化所提供护理的质量。
采用描述性统计、χ检验、Wilcoxon秩和检验和运行图进行分析。
儿科住院医师报告称，CEG实施后他们的信心和知识得分更高。在确定的91名患者中，62名符合纳入标准。CEG实施前的中位数得分为14±7，实施后的中位数得分为15.5±6。Wilcoxon秩和检验显示，CEG实施后AUB评估和管理得分存在差异（P = 0.09）。运行图数据显示没有变化或趋势（总体中位数得分，14分）。实施前后，最常因未评估个人/家族凝血障碍病史而扣分。护理方面最大的改善在于适当的药物剂量和处置。
我们为儿科急诊科的AUB管理设计了一个CEG和教育干预措施。这些结果表明，我们的CEG可能是改善青少年AUB急诊护理的有效工具，并且可以提高受训人员管理这种情况的信心，尽管还需要更多周期的研究。
