Rooplalsingh Rajiv, Edwards Felicity, Affleck Julia, Young Patrick, Tabah Alexis, Carmichael Sinead, Chappell Belinda, Fung Andrea, Jacobs Kylie, Laupland Kevin, Ramanan Mahesh
Department of Anaesthesia, Royal Brisbane and Women's Hospital, Brisbane, QLD 4029, Australia.
Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia.
Healthcare (Basel). 2024 Aug 5;12(15):1549. doi: 10.3390/healthcare12151549.
(1) Background: We aim to examine and improve phosphate prescribing as part of a quality assurance program by examining the change in the proportion of patients receiving phosphate with normal or high preceding serum phosphate concentrations before and after the introduction of the 24 h time limit to default phosphate prescription. (2) Methods: This was a quality assurance study conducted across three Australian adult intensive care units (ICUs). All adult patients with ICU lengths of stay greater than or equal to 48 h who had their serum phosphate concentrations measured were included. A 24 h time limit was introduced to the protocolised prescription in the electronic clinical information system for enteral and intravenous phosphate at participating ICUs. Patient characteristics, phosphate administration, and outcomes were compared before and after this time limit was introduced. The primary outcome was the proportion of patients to whom phosphate was prescribed after measurement of a normal or high serum phosphate level. Secondary outcomes were ICU length of stay, mortality, and discharge destination. (3) Results: A total of 1192 patients were included from three ICUs over the two periods. The proportion of patients with a normal or high measured phosphate level who then received phosphate supplementation was significantly lower in the second study period (30.3% vs. 9.9%; < 0.001). This difference persisted when adjusted for potential confounders in a mixed-effects logistic regression model (an adjusted odds ratio for receiving phosphate with normal or high serum concentration 0.214, 95% confidence interval of 0.132-0.347; < 0.001). No significant difference was seen in the typical ICU length of stay, in-hospital case-fatality rate, and hospital discharge destination between these groups. (4) Conclusions: This multicentre before-after study has demonstrated that the introduction of a 24 h limit on electronic phosphate prescriptions resulted in significantly fewer patients receiving phosphate when their serum phosphate concentration was normal or high, without any adverse impact on patient outcomes.
（1）背景：我们旨在通过检查在引入24小时默认磷酸盐处方时限前后，血清磷酸盐浓度正常或偏高的患者接受磷酸盐治疗的比例变化，来审视并改进磷酸盐处方，这是质量保证计划的一部分。（2）方法：这是一项在澳大利亚三个成人重症监护病房（ICU）开展的质量保证研究。纳入所有入住ICU时长大于或等于48小时且测量了血清磷酸盐浓度的成年患者。在参与研究的ICU的电子临床信息系统中，对肠内和静脉用磷酸盐的标准化处方引入了24小时时限。在引入该时限前后，比较患者特征、磷酸盐给药情况及结局。主要结局是在血清磷酸盐水平测量正常或偏高后接受磷酸盐处方的患者比例。次要结局是ICU住院时长、死亡率及出院去向。（3）结果：在两个时间段内，三个ICU共纳入1192例患者。在第二个研究时间段，测量的磷酸盐水平正常或偏高后接受磷酸盐补充治疗的患者比例显著降低（30.3%对9.9%；P<0.001）。在混合效应逻辑回归模型中对潜在混杂因素进行调整后，这种差异依然存在（血清浓度正常或偏高时接受磷酸盐治疗的调整比值比为0.214，95%置信区间为0.132 - 0.347；P<0.001）。这些组之间在典型的ICU住院时长、院内病死率及出院去向方面未观察到显著差异。（4）结论：这项多中心前后对照研究表明，在电子磷酸盐处方中引入24小时时限后，血清磷酸盐浓度正常或偏高的患者接受磷酸盐治疗的人数显著减少，且对患者结局无任何不良影响。
