Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI.
Department of Surgery, University of Michigan, Ann Arbor, MI.
Surgery. 2022 Mar;171(3):777-784. doi: 10.1016/j.surg.2021.09.040. Epub 2021 Dec 4.
Open long-bone fractures represent a complex injury within the trauma system. Guidelines recommend antibiotics be given within 60 minutes of patient arrival to the emergency department. We sought to measure and improve the timeliness of antibiotic administration at the patient, hospital, and population level within a collaborative quality initiative.
Trauma collaborative quality initiative data (January 2017 to December 2020) were analyzed from 34 American College of Surgeons Committee on Trauma verified level 1 and level 2 trauma centers. Inclusion criteria were adult patients (≥16 years), injury severity score ≥5, and open tibia or femur fracture. After the baseline year, hospitals were scored annually on a pay-for-performance metric based on patients receiving antibiotics within 120 minutes of emergency department arrival. Univariate tests examined the differences between baseline and subsequent year(s) performance. A multivariable logistic regression assessed the factors associated with meeting this target time.
There were 2,624 patients with an open long-bone fracture. In the baseline year (2017), 76.9% of patients received antibiotics in ≤120 minutes, with a mean time of 57.9 ± 63.3 minutes. After implementing collaborative quality initiative-wide targets, performance significantly improved in subsequent years (2018, 2019, 2020). The collaborative quality initiative achieved their goal of ≥85% of patients receiving antibiotics in ≤120 minutes in 2019 (87.9%) and 2020 (88.5%), with a mean time of 43.3 ± 54.8 minutes (P < .05 vs 2017).
A pay-for-performance process measure within a statewide trauma collaborative quality initiative improved the timely administration of antibiotics to patients with open fractures. Work remains to align compliance with the guideline target of <60 minutes and to identify factors involved in the delay of administration.
开放性长骨骨折是创伤系统中的一种复杂损伤。指南建议在患者到达急诊部的 60 分钟内给予抗生素。我们试图在协作质量倡议中从患者、医院和人群层面上衡量和提高抗生素给药的及时性。
从 34 个美国外科医师学会创伤委员会认证的 1 级和 2 级创伤中心分析了创伤协作质量倡议数据（2017 年 1 月至 2020 年 12 月）。纳入标准为成年患者（≥16 岁）、损伤严重程度评分≥5 分和开放性胫骨或股骨骨折。在基线年后，医院根据患者在到达急诊部后 120 分钟内接受抗生素的情况，每年根据绩效进行评分。单变量检验分析了基线后和后续年份的表现差异。多变量逻辑回归评估了与达到这一目标时间相关的因素。
共有 2624 例开放性长骨骨折患者。在基线年（2017 年），76.9%的患者在≤120 分钟内接受了抗生素治疗，平均时间为 57.9±63.3 分钟。在实施协作质量倡议的广泛目标后，后续年份的表现显著改善（2018 年、2019 年、2020 年）。协作质量倡议在 2019 年（87.9%）和 2020 年（88.5%）达到了他们的目标，即≥85%的患者在≤120 分钟内接受抗生素治疗，平均时间为 43.3±54.8 分钟（P<.05 与 2017 年相比）。
在全州创伤协作质量倡议中，基于绩效付费的过程措施提高了开放性骨折患者抗生素的及时给药。仍需努力使符合指南规定的<60 分钟的目标，并确定给药延迟的相关因素。
