Reducing routine group and save testing in emergency laparoscopic appendicectomy surgery: a quality improvement project assessing the triple bottom line.

IF 1.3 Q4 HEALTH CARE SCIENCES & SERVICES
Cyra Mackintosh, Emanuele Gammeri, Vrettos Ierodiakonou, Dominic Furniss
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引用次数: 0

Abstract

Introduction: There is compelling evidence supporting the omission of routine group and save (G&S) testing pre-operatively in emergency laparoscopy where appendicitis is suspected. Most studies are retrospective; however, one study prospectively demonstrated safe application in laparoscopic cholecystectomies only. We sought to assess safety, cost, and environmental and social savings-the triple bottom line-of omitting routine G&S testing in laparoscopic appendicectomies, by undertaking a quality improvement project at a busy district general hospital.

Methods: All patients who underwent an emergency laparoscopy +/- appendicectomy, between 1 November 2020 and 31 October 2021, were retrospectively reviewed, and cross-referenced to haematological testing and blood product dispensation data. A cost of £15 was applied to processed G&S samples and £1.89 to rejected samples. A carbon cost of 1,066 g CO2 emissions (CO2 e) was applied to all samples. We then prospectively undertook a 6-month pilot intervention to omit routine G&S testing in these cases. Patients from either cohort who required blood transfusions underwent a deep dive to identify risk factors.

Results: Pre-intervention, 281/392 (71.7%) of patients had valid G&S samples prior to their procedure and no patient required blood products during their episode. Post-intervention, 56/189 (29.1%) patients had valid G&S samples. One patient with chronic anaemia required a preoperative blood transfusion. Pre-intervention, G&S testing cost £22.24 and 1.7 kg CO2 e per laparoscopy. Post-intervention, the cost reduced to £9.78 and 0.7 kg CO2 e per laparoscopy. The intervention saved £5,021 and 353 kg CO2 e, and our institution has adopted a selective approach, based on clinical risk, for these cases indefinitely.

Conclusion: Routine G&S testing in emergency laparoscopy +/- appendicectomy is unnecessary, costing money and time and producing carbon emissions. With effective communication of risk-mitigating factors, practice can shift from high to low rates of preoperative testing. There are further savings accessible by applying this method to other surgical procedures using a risk-based approach.

急诊腹腔镜阑尾切除术中减少常规分组和节省试验:一个评估三重底线的质量改进项目。
有令人信服的证据支持在怀疑阑尾炎的急诊腹腔镜术前省略常规组和组(G&S)检测。大多数研究是回顾性的;然而,一项研究前瞻性地证明了仅在腹腔镜胆囊切除术中的安全应用。通过在一家繁忙的地区综合医院开展质量改进项目,我们试图评估腹腔镜阑尾切除术中省略常规G&S测试的安全性、成本、环境和社会节约——三重底线。方法:回顾性分析2020年11月1日至2021年10月31日期间所有接受急诊腹腔镜+/-阑尾切除术的患者,并交叉参考血液学检测和血液制品分配数据。处理过的G&S样品的费用为15英镑,拒绝样品的费用为1.89英镑。所有样本的碳成本为1066 g CO2排放(CO2 e)。然后,我们前瞻性地进行了为期6个月的试点干预,以省略这些病例的常规G&S测试。两个队列中需要输血的患者都进行了深入研究,以确定危险因素。结果:干预前,281/392(71.7%)患者在手术前有有效的G&S样本,在发作期间没有患者需要血液制品。干预后,56/189(29.1%)患者有有效的G&S样本。一名慢性贫血患者需要术前输血。干预前,G&S检查费用为22.24英镑,每次腹腔镜检查二氧化碳排放量为1.7公斤。干预后,成本降至9.78英镑,每次腹腔镜检查二氧化碳排放量为0.7公斤。干预节省了5021英镑和353公斤二氧化碳,我们的机构根据临床风险,对这些病例采取了选择性的方法。结论:急诊腹腔镜+/-阑尾切除术常规G&S检测是不必要的,既费时又费钱,还会产生碳排放。通过对风险缓解因素的有效沟通,实践可以从术前检测的高率转变为低率。通过将这种方法应用于基于风险的其他外科手术,可以进一步节省费用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Open Quality
BMJ Open Quality Nursing-Leadership and Management
CiteScore
2.20
自引率
0.00%
发文量
226
审稿时长
20 weeks
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