J Healthc Qual. 2021;43(5):e77-e83. doi: 10.1097/JHQ.0000000000000288.
As part of an institutional quality improvement (QI) initiative for the 2018-2019 academic year, orthopedic residents at our tertiary center were incentivized to bring over 75% of hip fracture patients with American Society of Anesthesiologists (ASA) Class 2 or less to surgery in under 24 hours, compared to the baseline rate of 55.9%. The time between admission and surgery for hip fracture patients with ASA class 2 or less was prospectively recorded. At the end of the study period, a retrospective comparison was performed between patients treated before and after the resident QI initiative. The percentage of patients who underwent surgery within 24 hours of admission increased significantly in the Study Cohort compared to the Baseline Cohort (78.6% vs. 55.9%, p = .037). Length of stay was shorter in the Study Cohort compared to the Baseline Cohort (3 days vs. 4 days, p = .01), whereas readmissions (3.6% vs. 4.4%, p = .85) and discharges to skilled nursing facilities (60.7% vs. 57.4%, p = .76) were comparable between both cohorts. A goal-directed, resident-led QI initiative was associated with a significantly increased percentage of hip fragility fracture patients who underwent surgery in less than 24 hours.
作为 2018-2019 学年机构质量改进 (QI) 计划的一部分，我们的三级中心的骨科住院医师被激励将超过 75%的美国麻醉师协会 (ASA) 分级 2 或更低的髋部骨折患者在 24 小时内进行手术，而基线率为 55.9%。ASA 分级 2 或更低的髋部骨折患者从入院到手术的时间被前瞻性记录下来。在研究结束时，对 QI 计划前后的患者进行了回顾性比较。与基线队列相比，研究队列中在入院 24 小时内接受手术的患者比例显著增加（78.6%比 55.9%，p =.037）。与基线队列相比，研究队列的住院时间更短（3 天比 4 天，p =.01），而再入院率（3.6%比 4.4%，p =.85）和出院到熟练护理设施（60.7%比 57.4%，p =.76）在两组之间相似。一项以目标为导向、由住院医师领导的 QI 计划与髋部脆性骨折患者在 24 小时内接受手术的比例显著增加有关。
