Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Roma, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy.
Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Roma, Italy.
Int J Infect Dis. 2019 Mar;80:105-110. doi: 10.1016/j.ijid.2019.01.025. Epub 2019 Jan 22.
Clostridium Difficile Infections (CDIs) have been increasing both in incidence and in severity, representing a big public health concern.
The aim of this study was to evaluate the impact of a recently implemented Critical Pathway (CP) focused on patients with CDI in an Italian Teaching Hospital.
The CP implementation consisted of intervention aimed to faster diagnosis and appropriateness in admission and discharge point of care; activation of a multidisciplinary team; staff training; information to patients and caregivers. In a pre-post retrospective observational study, volume, process and outcome indicators were analyzed.
A total of 228 patients (128 in 2013 and 100 in 2016) were included. A decrease in the absolute number of access to the Emergency Department (p=0.02) and an increase in hospitalization in more appropriate ward (ie gastroenterology ward, p<0.001) were found. The median hospital length of stay decreased from 20.5 (12.5-31) days in 2013 to 16.5 (7-31) days in 2016 (p=0.05). With regards to outcome indicators, an increase of discharge to home and a decrease of discharge to long term facilities were showed (p=0.01 both). Despite a reduction, no statically significant differences in mortality between 2013 and 2016 were revealed by the analysis.
In conclusion, we found quality improvement in patient hospital management. Our experience confirms that the implementation of the CP increases the appropriateness in hospital quality of care.
艰难梭菌感染（CDI）的发病率和严重程度都在增加，这是一个重大的公共卫生问题。
本研究旨在评估在意大利一所教学医院实施的一项针对 CDI 患者的重点治疗路径（CP）对患者管理的影响。
CP 的实施包括旨在加快诊断和入院及出院时机的适当性的干预措施；激活多学科团队；员工培训；向患者和护理人员提供信息。在回顾性的前后观察研究中，分析了数量、过程和结果指标。
共纳入 228 例患者（2013 年 128 例，2016 年 100 例）。发现急诊就诊的绝对人数减少（p=0.02），更多患者入住更合适的病房（即胃肠科病房，p<0.001）。2013 年住院时间中位数为 20.5（12.5-31）天，2016 年为 16.5（7-31）天（p=0.05）。在结果指标方面，出院回家的比例增加，而长期护理机构的出院比例下降（两者均为 p=0.01）。尽管有所减少，但分析并未显示 2013 年和 2016 年之间死亡率有统计学意义的差异。
总之，我们发现患者住院管理质量有所提高。我们的经验证实，CP 的实施提高了医院护理质量的适当性。
