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下单前“三思”:减少不必要实验室检测的多学科倡议

"THINK" Before You Order: Multidisciplinary Initiative to Reduce Unnecessary Lab Testing.

作者信息

Shinwa Masih, Bossert Adam, Chen Iris, Cushing Anna, Dunn Andrew S, Poeran Jashvant, Weinstein Sally, Cho Hyung J

出版信息

J Healthc Qual. 2019 May/Jun;41(3):165-171. doi: 10.1097/JHQ.0000000000000157.

Abstract

Inappropriate daily lab testing can have adverse effects on patients, including anemia, pain, and interruption of sleep. We implemented a student-led, multifaceted intervention featuring clinician education, publicity campaign, gamification, and system changes, including a novel nurse-driven protocol to reduce unnecessary daily lab testing in a teaching hospital. We applied a quasi-experimental interrupted time series design with a segmented regression analysis to estimate changes before and after our 14-month intervention with a comparison to a control surgical unit. There was an increasing trend in the baseline period, which was mitigated by the intervention (postintervention effect estimate -0.04 labs per patient day/month, p < .05), which was not seen in the control unit. Estimated cost savings was $94,269 ($6,734/month). A student-led, multidisciplinary campaign involving nurse-driven pathway, education, publicity, gamification, and system changes was effective in reducing daily lab testing.

摘要

不适当的每日实验室检查会对患者产生不良影响,包括贫血、疼痛和睡眠中断。我们实施了一项由学生主导的多方面干预措施,包括临床医生教育、宣传活动、游戏化以及系统变革,其中包括一项由护士推动的新方案,以减少教学医院中不必要的每日实验室检查。我们采用了准实验性中断时间序列设计和分段回归分析,以估计我们为期14个月的干预前后的变化,并与一个对照外科科室进行比较。基线期存在上升趋势,干预措施使其得到缓解(干预后效应估计为每位患者每天/每月减少0.04次检查,p < .05),而对照科室未出现这种情况。估计节省成本94,269美元(每月6,734美元)。一项由学生主导、涉及护士推动的路径、教育、宣传、游戏化和系统变革的多学科活动,在减少每日实验室检查方面是有效的。

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