Trauma and Acute Care Surgery, HCA Florida Kendall Hospital, Miami, FL, USA.
Emergency Medicine, HCA Florida Kendall Hospital, Miami, FL, USA.
Am Surg. 2024 Oct;90(10):2522-2529. doi: 10.1177/00031348241248783. Epub 2024 Apr 24.
Patients with emergency surgical conditions (ESCs) experience higher complication rates than those without emergency conditions. Our purpose was to improve time-based key performance indicators (KPIs) of care for ESC patients, including diagnostic workup, empiric stabilization, and referral to definitive care.
A rapid response program (ESTAT) was developed to screen for and coordinate optimal, timely care for a spectrum of high-risk ESCs, from the patient's index clinical encounter up to definitive care. The Mann-Whitney test assessed whether any differences in KPIs were statistically significant ( < .05) before compared to after the implementation of ESTAT.
98 patients were identified: 44 in ESTAT group (70% age ≥55, 57% male); 54 in control group (57% age ≥55, 44% male). There were significant decreases from time of index clinical encounter to resuscitation (5 min. vs 34 min., < .001), to diagnostic imaging (52 min. vs 1 hr. 19 min., = .004), and to definitive care (2 hr. 17 min. vs 3 hr. 51 min., = .007) in the ESTAT group compared to the control group, respectively.
Improving time-based KPIs for delivery of clinical services is a common goal of medical emergency response systems (MERS) in numerous specialties. Implementation of an ESTAT program provides a screening tool for at-risk patients and reduces time to stabilize, diagnose and triage to definitive surgical intervention. These time benefits may ultimately translate to reduced complication rates for ESC patients. ESTAT may also represent a patient onboarding mechanism for surgical specialty verification programs promoted by quality improvement committees of various professional societies.
急诊手术条件（ESC）患者比非急诊条件患者的并发症发生率更高。我们的目的是改善 ESC 患者的基于时间的关键绩效指标（KPI），包括诊断性检查、经验性稳定和转介至确定性治疗。
开发了快速反应计划（ESTAT），以筛查和协调从患者的初始临床就诊到确定性治疗的一系列高危 ESC 的最佳及时治疗。使用 Mann-Whitney 检验评估在实施 ESTAT 前后 KPI 是否存在统计学差异（<.05）。
共确定了 98 例患者：ESTAT 组 44 例（≥55 岁患者占 70%，男性占 57%）；对照组 54 例（≥55 岁患者占 57%，男性占 44%）。ESTAT 组从初始临床就诊到复苏（5 分钟比 34 分钟，<.001）、诊断性影像学检查（52 分钟比 1 小时 19 分钟，=.004）和确定性治疗（2 小时 17 分钟比 3 小时 51 分钟，=.007）的时间明显缩短，与对照组相比。
改善提供临床服务的基于时间的 KPI 是众多专业的医疗应急响应系统（MERS）的共同目标。实施 ESTAT 计划为高危患者提供了一种筛查工具，并缩短了稳定、诊断和分诊至确定性手术干预的时间。这些时间优势最终可能会降低 ESC 患者的并发症发生率。ESTAT 也可能代表各种专业协会的质量改进委员会推广的外科专业验证计划的患者入组机制。
