Reduction of Chest Drain Overuse Through Implementation of a Pleural Drainage Order Set.

IF 1.2 4区医学 Q4 HEALTH CARE SCIENCES & SERVICES

Quality Management in Health Care Pub Date : 2024-07-01 Epub Date: 2024-06-26 DOI:10.1097/QMH.0000000000000427

Pattraporn Tajarernmuang, David Valenti, Anne V Gonzalez, Giovanni Artho, Mary Tsatoumas, Stéphane Beaudoin

{"title":"Reduction of Chest Drain Overuse Through Implementation of a Pleural Drainage Order Set.","authors":"Pattraporn Tajarernmuang, David Valenti, Anne V Gonzalez, Giovanni Artho, Mary Tsatoumas, Stéphane Beaudoin","doi":"10.1097/QMH.0000000000000427","DOIUrl":null,"url":null,"abstract":"Background and objectives: Small chest drains are used in many centers as the default drainage strategy for various pleural effusions. This can lead to drain overuse, which may be harmful. This study aimed to reduce chest drain overuse.Methods: We studied consecutive pleural procedures performed in the radiology department before (August 1, 2015, to July 31, 2016) and after intervention (September 1, 2019, to January 31, 2020). Chest drains were deemed indicated or not based on criteria established by a local interdisciplinary work group. The intervention consisted of a pleural drainage order set embedded in electronic medical records. It included indications for chest drain insertion, prespecified drain sizes for each indication, fluid analyses, and postprocedure radiography orders. Overall chest drain use and proportion of nonindicated drains were the outcomes of interest.Results: We reviewed a total of 288 procedures (pre-intervention) and 155 procedures (post-intervention) (thoracentesis and drains). Order-set implementation led to a reduction in drain use (86.5% vs 54.8% of all procedures, P < .001) and reduction in drain insertions in the absence of an indication (from 45.4% to 29.4% of drains, P = .01). The need for repeat procedures did not increase after order-set implementation (22.0% pre vs 17.7% post, P = .40). Complication rates and length of hospital stay did not differ significantly after the intervention. More pleural infections were treated with drain sizes of 12Fr and greater (31 vs 70%, P < .001) after order-set deployment, and direct procedural costs were reduced by 27 CAN$ per procedure.Conclusion: Implementation of a pleural drainage order-set reduced chest drain use, improved procedure selection according to clinical needs, and reduced direct procedural costs. In institutions where small chest drains are used as the default drainage strategy for pleural effusions, this order set can reduce chest drain overuse.","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Quality Management in Health Care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/QMH.0000000000000427","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/26 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Background and objectives: Small chest drains are used in many centers as the default drainage strategy for various pleural effusions. This can lead to drain overuse, which may be harmful. This study aimed to reduce chest drain overuse.

Methods: We studied consecutive pleural procedures performed in the radiology department before (August 1, 2015, to July 31, 2016) and after intervention (September 1, 2019, to January 31, 2020). Chest drains were deemed indicated or not based on criteria established by a local interdisciplinary work group. The intervention consisted of a pleural drainage order set embedded in electronic medical records. It included indications for chest drain insertion, prespecified drain sizes for each indication, fluid analyses, and postprocedure radiography orders. Overall chest drain use and proportion of nonindicated drains were the outcomes of interest.

Results: We reviewed a total of 288 procedures (pre-intervention) and 155 procedures (post-intervention) (thoracentesis and drains). Order-set implementation led to a reduction in drain use (86.5% vs 54.8% of all procedures, P < .001) and reduction in drain insertions in the absence of an indication (from 45.4% to 29.4% of drains, P = .01). The need for repeat procedures did not increase after order-set implementation (22.0% pre vs 17.7% post, P = .40). Complication rates and length of hospital stay did not differ significantly after the intervention. More pleural infections were treated with drain sizes of 12Fr and greater (31 vs 70%, P < .001) after order-set deployment, and direct procedural costs were reduced by 27 CAN$ per procedure.

Conclusion: Implementation of a pleural drainage order-set reduced chest drain use, improved procedure selection according to clinical needs, and reduced direct procedural costs. In institutions where small chest drains are used as the default drainage strategy for pleural effusions, this order set can reduce chest drain overuse.

查看原文本刊更多论文

通过实施胸腔引流订单集，减少胸腔引流管的过度使用。

背景和目的：许多中心将小型胸腔引流管作为各种胸腔积液的默认引流策略。这可能会导致引流管过度使用，从而造成危害。本研究旨在减少胸腔引流管的过度使用：我们研究了放射科在干预前（2015 年 8 月 1 日至 2016 年 7 月 31 日）和干预后（2019 年 9 月 1 日至 2020 年 1 月 31 日）进行的连续胸腔手术。胸腔引流是根据当地跨学科工作组制定的标准来判定是否适用的。干预措施包括在电子病历中嵌入胸腔引流术医嘱集。其中包括胸腔引流管插入的适应症、针对每种适应症预先指定的引流管尺寸、液体分析以及术后放射检查订单。胸腔引流管的总体使用情况和未指定引流管的比例是我们关注的结果：我们共审查了 288 例手术（干预前）和 155 例手术（干预后）（胸腔穿刺术和引流管）。订单设置的实施减少了引流管的使用（占所有手术的86.5%对54.8%，P < .001），并减少了在无指征的情况下插入引流管（从45.4%减少到29.4%，P = .01）。订单设置实施后，重复手术的需求并未增加（实施前为22.0%，实施后为17.7%，P = .40）。干预后，并发症发生率和住院时间没有明显差异。在使用顺序集后，更多的胸膜感染患者使用了12Fr或更大尺寸的引流管（31% vs 70%，P < .001），每次手术的直接费用减少了27加元：结论：胸腔引流顺序集的实施减少了胸腔引流管的使用，改善了根据临床需求选择手术的情况，并降低了直接手术成本。在使用小型胸腔引流管作为胸腔积液默认引流策略的医疗机构中，该订单集可减少胸腔引流管的过度使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Quality Management in Health Care HEALTH CARE SCIENCES & SERVICES-

CiteScore

1.90

自引率

8.30%

发文量

108

期刊介绍： Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it: -Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes; -Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes; -Fosters the application of quality management science to patient care processes and clinical decision-making; -Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes; -Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.