开放性骨折患者抗生素使用管理的绩效改进项目

A Performance Improvement Project in Antibiotic Administration for Open Fractures.

机构信息

From the Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, NE (Dr. Siebler, Dr. Ogden, Dr. Deans, and Dr. Mormino), Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. McCarthy), Department of Infectious Disease, University of Nebraska Medical Center, Omaha, NE (Dr. Hewlett), and Department of Public Health, University of Nebraska Medical Center, Omaha, NE (Lyden).

出版信息

J Am Acad Orthop Surg. 2020 Jan 1;28(1):e34-e40. doi: 10.5435/JAAOS-D-18-00528.

DOI:10.5435/JAAOS-D-18-00528

PMID:30998566

Abstract

INTRODUCTION

To evaluate the effects of a trauma performance improvement project involving standardized protocols for the administration of antibiotics in open fractures at a level one trauma center. This study specifically evaluated the protocol's efficacy for improving the timing of delivery and appropriate therapy administration and sought to identify factors that lead to the delay in antibiotic delivery.

METHODS

Retrospective comparative cohort study comparing patients with open fractures treated at our hospital between January 2013 and September 2015 (group 1) and between April 2016 and June 2017 (group 2). Group 1 was treated before implementation of the performance improvement project and group 2 was treated after implementation.

RESULTS

Group 1 consisted of 79 patients and group 2 consisted of 80 patients with open fractures. Each group was statistically similar in patient and injury factors. Group 1 received antibiotics at an average of 97 minutes after arrival to our hospital while group 2 patients received them at an average of 46 minutes (P < 0.0001). Average time from admission to initial evaluation improved from 10 to 3 minutes (P < 0.0001). Average time from evaluation to antibiotic order placement improved from 77 to 26 minutes (P < 0.0001). Average time from order entry to antibiotic administration showed no significant difference (12 versus 15 minutes, P = 0.25). Thirty-four percent (27/79) of group 1 patients and 84% (67/80) of group 2 patients received antibiotics within 1 hour of admission (P < 0.0001), while 91% and 99% received antibiotics within 3 hours, respectively (P = 0.03).

DISCUSSION

The described multifaceted performance improvement protocol was highly effective for producing a more coordinated, efficient, and timely process for administration of antibiotics to patients with open fractures at our hospital. This protocol may be adopted and implemented at other facilities.

LEVEL OF EVIDENCE

Therapeutic level III.

摘要

简介

评估一个涉及一级创伤中心开放性骨折中抗生素使用标准化方案的创伤绩效改进项目的效果。本研究专门评估了该方案在改善抗生素给药时机和适当治疗管理方面的疗效，并试图确定导致抗生素给药延迟的因素。

方法

回顾性比较队列研究，比较我院 2013 年 1 月至 2015 年 9 月（第 1 组）和 2016 年 4 月至 2017 年 6 月（第 2 组）治疗的开放性骨折患者。第 1 组在实施绩效改进项目之前治疗，第 2 组在实施之后治疗。

结果

第 1 组有 79 例开放性骨折患者，第 2 组有 80 例。每组在患者和损伤因素方面均具有统计学可比性。第 1 组在到达我院后平均 97 分钟内接受抗生素治疗，而第 2 组患者在平均 46 分钟内接受抗生素治疗（P<0.0001）。从入院到首次评估的平均时间从 10 分钟缩短至 3 分钟（P<0.0001）。从评估到抗生素医嘱下达的平均时间从 77 分钟缩短至 26 分钟（P<0.0001）。医嘱输入到抗生素给药的平均时间无显著差异（12 分钟比 15 分钟，P=0.25）。第 1 组 34%（27/79）的患者和第 2 组 84%（67/80）的患者在入院后 1 小时内接受抗生素治疗（P<0.0001），而分别有 91%和 99%的患者在 3 小时内接受抗生素治疗（P=0.03）。