优化内镜逆行胰胆管造影术中胆道支架置入的适应症:一项旨在加强患者护理和降低医疗资源利用率的质量改进计划。

IF 3.3 Q2 GASTROENTEROLOGY & HEPATOLOGY
Suliman Alhaidari, Ibrahim Alzahrani, Manar Alhanaee, Alan Decanini, Mahmod Mohamed, Sergio Zepeda-Gomez, Pamela Mathura, Julie Zhang, Gurpal Sandha
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引用次数: 0

摘要

背景:我们对 2020 年 1 月至 2021 年 1 月期间胆道支架的使用情况进行了回顾性病历审计。在接受内镜逆行胰胆管造影术(ERCP)的胆总管(CBD)结石患者中,发现有16%的患者未按指南进行支架植入。目的:根据已发布的指南,同步CBD结石患者胆道支架植入的临床适应症:方法:采用质控前-后研究设计,完成病历审核并与ERCP团队(6人)共享。胆道支架植入指征与已发布的指南进行比较,由两名审查员独立评估(计算卡帕统计量)。QI 干预包括教育课程和季度实践审核。结果:干预后期间,共有 661 名患者(337 名女性)接受了 885 次 ERCP,平均年龄为 59±19 岁(12-98 岁)。在 661 名患者中,有 384 人(58%)因 CBD 结石而转诊。在首次ERCP中,共放置了192个胆道支架(105个塑料支架,85个金属支架)(192/661,29%),而干预前一年则为223/598,37%,P=0.2。此外,13/192(7%)个支架的放置不符合已公布的指南(kappa=0.53),而干预前一年为63/223(28%)(p结论:通过审计和反馈教育,缩小了ERCP期间胆道支架置入从知识到实践的差距,尤其是在CBD结石患者中。这显著减少了可避免的支架植入和额外的ERCP随访,节省了医疗资源。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Optimising the indications for biliary stent placement during endoscopic retrograde cholangiopancreatography: a quality improvement initiative to enhance patient care and reduce healthcare resource utilisation.

Background: A retrospective chart audit was performed to review biliary stent utilisation from January 2020 to January 2021. Non-guideline-based stent insertion was identified in 16% of patients with common bile duct (CBD) stones presenting for endoscopic retrograde cholangiopancreatography (ERCP). To improve this knowledge-practice gap, a quality improvement (QI) intervention was devised and trialled.

Aim: To synchronise clinical indications for biliary stent insertion in patients with CBD stones in accordance with published guidelines.

Methods: Using a QI pre-post study design, chart audits were completed and shared with the ERCP team (n=6). Indication for biliary stent insertion was compared to published guidelines assessed by two reviewers independently (kappa statistic calculated). The QI intervention included an education session and quarterly practice audits. An interrupted time series with segmented regression was completed.

Results: A total of 661 patients (337 F), mean age 59±19 years (range 12-98 years), underwent 885 ERCPs during this postintervention period. Of 661 patients, 384 (58%) were referred for CBD stones. A total of 192 biliary stents (105 plastic, 85 metal) were placed during the first ERCP (192/661, 29%), as compared with the preintervention year (223/598, 37%, p=0.2). Furthermore, 13/192 stents (7%) were placed not in accordance with published guidelines (kappa=0.53), compared with 63/223 (28%) in the preintervention year (p<0.0001). A 75% reduction in overall avoidable stent placement was achieved with a direct cost avoidance of $C97 500. For the CBD stone subgroup, there was an 88% reduction in avoidable biliary stent placement compared with the preintervention year (8/384, 2% vs 61/375, 16%, p<0.0001).

Conclusions: Education with audit and feedback supported the closing of a knowledge-to-practice gap for biliary stent insertion during ERCP, especially in patients with CBD stones. This has resulted in a notable reduction of avoidable stent placements and additional follow-up ERCPs and an overall saving of healthcare resources.

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来源期刊
BMJ Open Gastroenterology
BMJ Open Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.90
自引率
3.20%
发文量
68
审稿时长
2 weeks
期刊介绍: BMJ Open Gastroenterology is an online-only, peer-reviewed, open access gastroenterology journal, dedicated to publishing high-quality medical research from all disciplines and therapeutic areas of gastroenterology. It is the open access companion journal of Gut and is co-owned by the British Society of Gastroenterology. The journal publishes all research study types, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Publishing procedures are built around continuous publication, publishing research online as soon as the article is ready.
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