实施一种新型的每日绩效改进检查表（PIC）可提高创伤患者酒精筛查和干预的依从性。
Implementation of a novel daily performance improvement checklist (PIC) improves alcohol screening and intervention compliance in trauma.
作者信息
Jeffery Michelle, Toussaint Ashley, Choron Rachel L, Englert Zachary P, Piplani Charoo, Murphy Timothy, Falcon Lisa A, Narayan Mayur, Teichman Amanda L
机构信息
Surgery, Division of Acute Care Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
出版信息
Trauma Surg Acute Care Open. 2024 Sep 28;9(1):e001517. doi: 10.1136/tsaco-2024-001517. eCollection 2024.
INTRODUCTION
Screening, brief intervention, and referral to treatment (SBIRT) has demonstrated up to 50% reduction in alcohol-related traumatic injury and is mandated by the American College of Surgeons for trauma center accreditation. While SBIRT effectiveness has been previously investigated, optimal implementation in the trauma setting has not. We sought to improve SBIRT compliance through integration of screening into a performance improvement checklist (PIC) deployed during morning report. We hypothesized that PIC would establish a self-sustaining model for improved alcohol screening/intervention.
METHODS
This was a retrospective study comparing trauma patients pre-PIC (January-May 2022) to post-PIC (January-May 2023) after PIC implementation in January 2023. The primary outcome was SBIRT performance. The PIC prompted alcohol intervention specialist consultation if blood alcohol content >80 mg/dL, <21 years old, or Alcohol Use Disorders Identification Test ≥8. Significance was determined if p<0.05.
RESULTS
There were 705 pre-PIC and 840 post-PIC patients. Pre-PIC unscreened patients were more often uninsured (13% vs. 25%, p<0.01) and black (8% vs. 14%, p=0.02) compared with screened pre-PIC patients. There were no significant differences among screened versus unscreened patients after PIC with respect to age, sex, race, or ethnicity (p>0.05). Overall, screening improved pre-PIC to post-PIC (52% vs. 88%, p<0.01) and the percentage of patients who screened positively also increased after PIC (8% vs. 23%, p<0.01). Brief intervention was unchanged (83% vs. 81%, p=1).
CONCLUSION
The PIC is a novel tool that demonstrated improved alcohol screening and referral. It improved compliance with SBIRT and reduced implicit bias in the population screened. Utilization of a PIC is easily translatable to other centers and could become a national standard to advance performance improvement.
LEVEL OF EVIDENCE
IV.
引言
筛查、简短干预和转介治疗（SBIRT）已证明可将与酒精相关的创伤性损伤减少多达50%，并且美国外科医师学会要求创伤中心认证必须开展此项工作。虽然此前已对SBIRT的有效性进行过调查，但尚未对其在创伤环境中的最佳实施情况进行研究。我们试图通过将筛查纳入早交班时使用的绩效改进检查表（PIC）来提高SBIRT的依从性。我们假设PIC将建立一个自我维持的模式，以改善酒精筛查/干预。
方法
这是一项回顾性研究，比较了2023年1月实施PIC之前（2022年1月至5月）和之后（2023年1月至5月）的创伤患者。主要结局是SBIRT的执行情况。如果血液酒精含量>80mg/dL、年龄<21岁或酒精使用障碍识别测试≥8，则PIC会促使咨询酒精干预专家。如果p<0.05，则具有统计学意义。
结果
PIC实施前有705例患者，实施后有840例患者。与PIC实施前接受筛查的患者相比，PIC实施前未接受筛查的患者更多为未参保者（13%对25%，p<0.01）和黑人（8%对14%，p=0.02）。PIC实施后，接受筛查和未接受筛查的患者在年龄、性别、种族或民族方面无显著差异（p>0.05）。总体而言，筛查率从PIC实施前提高到了实施后（52%对88%，p<0.01），PIC实施后筛查呈阳性的患者百分比也有所增加（8%对23%，p<0.01）。简短干预情况未变（83%对81%，p=1）。
结论
PIC是一种新型工具，可改善酒精筛查和转介。它提高了对SBIRT的依从性，并减少了所筛查人群中的隐性偏见。PIC的应用很容易推广到其他中心，并可能成为提高绩效的国家标准。
证据水平
四级
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