从减少心脏遥测监测过度使用的努力中吸取的教训。

Lessons Learned from Efforts to Reduce Overuse of Cardiac Telemetry Monitoring.

出版信息

Jt Comm J Qual Patient Saf. 2020 Aug;46(8):464-470. doi: 10.1016/j.jcjq.2020.05.001. Epub 2020 May 18.

DOI:10.1016/j.jcjq.2020.05.001

Abstract

BACKGROUND

Inappropriate use of telemetry monitoring is common, increasing costs, false alarms, and length of stay. The Society of Hospital Medicine and Choosing Wisely encourage the use of discontinuation protocols.

METHODS

This quality improvement initiative measured the impact of an educational intervention and distribution of performance reports for physicians and residents on the general medicine service. The intervention group received a 15-minute didactic session on appropriate indications for telemetry followed by weekly performance reports for 78 weeks. A segmented linear regression model and Student's t-test were used to determine intervention effects on percentage of patients on telemetry and telemetry orders lasting more than 48 hours.

RESULTS

Prior to the intervention, 4.8% of patients received telemetry monitoring; 13.4% of telemetry orders exceeded 48 hours. The control service had a baseline telemetry utilization of 2.4%; 1.2% of telemetry orders exceeded 48 hours. After the intervention, 3.9% of patients received telemetry monitoring; 10.6% of telemetry orders exceeded 48 hours. The control service had a postintervention telemetry utilization of 2.1%; 1.1% of telemetry orders exceeded 48 hours. The Student's t-test showed a statistically significant (p = 0.002) decrease in telemetry ordering rate on the intervention service and no significant change in the control group. However, when using segmented linear regression analysis, these changes could not be attributed to the intervention nor were there any significant changes in balancing metrics.

CONCLUSION

Education and weekly performance feedback did not significantly impact telemetry according to segmented linear regression results. Segmented linear regression analysis of an interrupted time series yielded significantly different results from a pre-post comparison using Student's t-test. Rigorous evaluation is vital to decreasing unnecessary care and successful reduction in unnecessary care may require interventions that capitalize on systems-level change.

摘要

背景

遥测监测的不当使用较为常见，会增加成本、产生误报并延长住院时间。医院医学学会和明智选择（Choosing Wisely）鼓励使用停止使用协议。

方法

这项质量改进计划衡量了对一般医学服务的医生和住院医师进行教育干预和发布绩效报告的影响。干预组接受了 15 分钟的遥测适当适应症的讲座，然后在 78 周内每周发布绩效报告。使用分段线性回归模型和学生 t 检验来确定干预对遥测患者比例和遥测医嘱持续时间超过 48 小时的影响。

结果

在干预之前，有 4.8%的患者接受遥测监测；13.4%的遥测医嘱超过 48 小时。对照组的基线遥测使用率为 2.4%；1.2%的遥测医嘱超过 48 小时。干预后，有 3.9%的患者接受遥测监测；10.6%的遥测医嘱超过 48 小时。对照组的干预后遥测使用率为 2.1%；1.1%的遥测医嘱超过 48 小时。学生 t 检验显示，干预组的遥测医嘱率有统计学显著（p=0.002）下降，对照组没有显著变化。然而，使用分段线性回归分析时，这些变化既不能归因于干预，也不能归因于平衡指标的任何显著变化。