Critical Care, East and North Hertfordshire NHS Trust, Stevenage, UK
Emergency Department, Princess Alexandra Hospital NHS Trust, Harlow, UK.
Emerg Med J. 2024 Sep 25;41(10):621-627. doi: 10.1136/emermed-2024-214013.
There is compelling evidence that AXRs have limited clinical value in the acute setting. Despite this, they are frequently used in many EDs. This quality improvement project (QIP) aimed to reduce unnecessary AXR use in a single-centre ED.
All consecutive AXRs conducted on patients aged 16 years and above in a District General Hospital ED in England between 2 August 2021 and 5 June 2022 were included. This period of time was divided into a pre-intervention and intervention period, during which iterative plan-do-study-act cycles were undertaken to implement a wide range of educational and system level interventions.
501 AXRs were performed during the QIP. The average number of AXRs per fortnight fell from 27.5 during the preintervention period to 17.6 during the intervention period and met criteria for special cause variation. No special cause variation in CT usage was observed, with an average number of 70.7 and 74 CT abdomen-pelvis scans during the preintervention and intervention periods, respectively. 119 (23.8%) AXRs showed acute and clinically significant findings, and of this group 118/119 (99.2%) underwent further imaging. In contrast, 382 (76.2%) AXRs had no acute or clinically significant findings, and of this group 344/382 (90.1%) proceeded to further imaging.
In this single-centre QIP, coordinated multidisciplinary interventions were effective in reducing unnecessary AXR usage without resulting in excess CTs. The methods and interventions described are easily reproducible at minimal expense and may be of interest to other departments undertaking quality improvement work in this area.
有确凿的证据表明，急性肾损伤（AKI）在急性情况下的临床价值有限。尽管如此，它们在许多急诊室中仍经常被使用。这项质量改进项目（QIP）旨在减少单一中心急诊室中不必要的 AKI 使用。
纳入 2021 年 8 月 2 日至 2022 年 6 月 5 日期间在英国一家地区综合医院急诊科进行的所有 16 岁及以上患者的连续 AKI。这一时间段被分为干预前和干预期间，在此期间，进行了迭代的计划-执行-研究-行动循环，以实施广泛的教育和系统层面的干预措施。
在 QIP 期间进行了 501 次 AKI。干预前每两周的 AKI 数量为 27.5 次，干预期间降至 17.6 次，符合特殊原因变化的标准。未观察到 CT 使用的特殊原因变化，干预前和干预期间的平均 CT 腹部-骨盆扫描次数分别为 70.7 和 74 次。119 次 AKI 显示出急性和临床显著的发现，其中 118/119（99.2%）进行了进一步的影像学检查。相比之下，382 次 AKI 没有急性或临床显著的发现，其中 344/382（90.1%）进行了进一步的影像学检查。
在这项单中心 QIP 中，协调的多学科干预措施有效地减少了不必要的 AKI 使用，而没有导致 CT 过度使用。所描述的方法和干预措施易于复制，费用低廉，可能对其他在该领域进行质量改进工作的部门感兴趣。
