Pediatric Critical Care, Children's Hospital of Illinois at OSF HealthCare Saint Francis Medical Center, Peoria, Illinois; and.
Acute Care Pediatric Nurse Practitioner Program, Department of Women, Children, and Family Nursing, Rush University College of Nursing, Chicago, Illinois.
J Extra Corpor Technol. 2022 Jun;54(2):123-127. doi: 10.1182/ject-123-127.
Laboratory testing is a helpful tool for clinicians, but can be costly and harmful to patients. A quality improvement project was initiated to reduce laboratory testing for patients receiving extracorporeal membrane oxygenation (ECMO) in a pediatric intensive care unit (PICU) at a tertiary care center. Preliminary data was gathered to demonstrate preimplementation practice, cost, and patient need for packed red blood cell (pRBC) transfusions. A new protocol was created by an interprofessional team based on best practice and benchmarking with high-performing organizations. The project was evaluated using two comparison groups, pre- and postimplementation for anyone receiving ECMO therapy in the PICU. The average laboratory tests per ECMO day decreased by 52% (128.4 vs. 61.1), cost per case decreased by 14.7%, pRBC transfusions decreased from 100% to 85%, length of stay (LOS) decreased by 8 days, and mortality rates decreased by 9.5%. The revised pediatric ECMO laboratory testing guidelines were successfully implemented and reduced laboratory cost without adverse effects on mortality rates or LOS.
实验室检测对临床医生很有帮助，但可能会给患者带来经济负担和伤害。在一家三级医疗中心的儿科重症监护病房（PICU），为减少体外膜肺氧合（ECMO）患者的实验室检测，启动了一项质量改进项目。初步收集数据以展示实施前的实践、成本和患者对浓缩红细胞（pRBC）输注的需求。一个由多专业团队根据最佳实践和与表现出色的组织的基准制定了一个新的方案。该项目通过两个比较组进行评估，分别为 PICU 中接受 ECMO 治疗的患者实施前后。每个 ECMO 日的实验室检测数量减少了 52%（从 128.4 项减少至 61.1 项），每个病例的成本降低了 14.7%，pRBC 输注从 100%降至 85%，住院时间（LOS）缩短了 8 天，死亡率降低了 9.5%。修订后的儿科 ECMO 实验室检测指南成功实施，降低了实验室成本，且对死亡率或 LOS 没有不利影响。
