Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Heart Center, Primary Children's Hospital, Salt Lake City, UT, USA.
Pediatr Cardiol. 2021 Apr;42(4):942-950. doi: 10.1007/s00246-021-02567-4. Epub 2021 Feb 13.
Our aim was to reduce the frequency of unnecessary testing used by pediatric cardiologists in the evaluation of pediatric patients with syncope or pre-syncopal symptoms without negatively affecting patient outcomes. Guidelines for cardiac testing in pediatric patients with syncope were developed and disseminated to members of our pediatric cardiology division. Educational brochures and water bottles labeled with tips on preventing syncope were made available to families and providers in our clinics. Compliance to the guidelines was tracked and shared with providers. Segmented regression analysis was used to model cardiac testing utilization and guideline compliance by provider over time before and after the implementation of the guidelines. A pre-intervention cohort of 237 patients (June 2014-May 2015) was compared to 880 post-intervention patients (August 2015-June 2019). There was a significant decrease in the utilization of unnecessary tests [odds ratio (OR) 0.3; 95% confidence interval (CI) 0.14, 0.65; p = 0.002] after the intervention. Charges associated with patient evaluation were significantly lower in the post-intervention cohort (interquartile range $0, $1378 vs $0, $213; p = 0.005). Post-intervention visits to emergency departments within our system were significantly decreased, with no change in the incidence of cardiac arrest, hospitalization for syncope, or referral to pediatric electrophysiologists. We demonstrated a significant reduction in the use of unnecessary testing and associated charges by developing guidelines related to the evaluation of pediatric patients with syncope or pre-syncopal symptoms. There was no demonstrable negative impact on patient outcomes.
我们的目的是减少儿科心脏病专家在评估晕厥或晕厥前症状的儿科患者时进行不必要的检查的频率，同时又不影响患者的预后。制定并向我们儿科心脏病科的成员分发了儿科晕厥患者心脏检查的指南。我们还向诊所的患者家庭和医务人员提供了带有预防晕厥小贴士的教育小册子和贴有标签的水瓶。我们对指南的遵循情况进行了跟踪，并与医务人员进行了分享。采用分段回归分析来对指南实施前后的一段时间内，根据提供者对心脏检查的使用和对指南的遵循情况进行建模。将 237 名患者（2014 年 6 月至 2015 年 5 月）的预干预队列与 880 名干预后患者（2015 年 8 月至 2019 年 6 月）进行了比较。干预后，不必要检查的使用率显著下降[比值比（OR）0.3；95%置信区间（CI）0.14，0.65；p=0.002]。干预后队列中与患者评估相关的费用明显降低（中位数 0，1378 美元与 0，213 美元；p=0.005）。我们系统内急诊就诊的次数明显减少，但心脏骤停、因晕厥住院或转介至儿科电生理学家的发生率没有变化。我们通过制定与晕厥或晕厥前症状的儿科患者评估相关的指南，显著减少了不必要的检查的使用和相关费用。而且患者的预后也没有受到负面影响。
