缩短血管通路抢救时间:来自单一机构临床实践改进方案的初步结果。

IF 1.3 Q4 HEALTH CARE SCIENCES & SERVICES
Kai Siang Chan, Enhui Yong, Li Zhang, Shufen Neo, Xueping Zhou, Joana Marie Eugenio Gray, Diomampo Katriz Abanto Elah, Ee Ling Ong, Ying Pan, Qiantai Hong, Malcolm Han Wen Mak, Lester Rhan Chaen Chong, Glenn Wei Leong Tan, Sundeep Punamiya, Gavin Lim, Gabriel Chan, Krishna Gummalla, Lawrence Han Hwee Quek, Pua Uei, Bien Peng Tan, Justin Kwan, Enming Yong
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引用次数: 0

摘要

背景:血栓形成是动静脉瘘(AVF)和/或动静脉移植(AVG)失败的最常见原因之一。指南建议在24-48小时内早期抢救AVF。我们的机构报告这些建议的依从性较差,在血管通路(VA)修复前的中位时间为3天。我们介绍了临床实践改进计划(CPIP)实施后的初步结果,以减少VA抢救的延迟。方法:CPIP分为三个阶段:CPIP前(2023年1月23日至4月30日)、CPIP干预前(2023年5月22日至9月3日)和CPIP干预后(2023年9月4日至2024年1月7日)。进行根本原因分析以确定导致VA抢救延迟的因素。所实施的措施包括建立一个多学科交流平台,就需要VA救助的案例进行交流,实施结构化工作流程和定期提醒,以确保遵守规定。结果:有82例(90.1%)患者在CPIP期间接受了VA抢救。中位年龄为67岁,男性居多(64%)。有45例(54.9%)患者在CPIP期间接受了早期VA抢救。运行图显示干预前和干预后的早期VA抢救率中位数分别为6.1%和81.0%。干预前和干预后的中位住院时间分别为5.65天和2.92天。在血栓性VA的CPIP期间,FC插入的发生率为17.1% (n=6/35)。8例患者在干预后未能获得早期VA抢救。干预后,每位患者节省的住院总费用降低了3144新元。结论:我们报告通过利益相关者的参与和使用结构化协议逐步实施措施,成功实施了我们的CPIP。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Reducing time for vascular access salvage: initial results from a single institution's clinical practice improvement programme.

Background: One of the most common causes of arteriovenous fistula (AVF) and/or arteriovenous graft (AVG) failure is thrombosis. Guidelines recommend early AVF salvage within 24-48 hours. Our institution reported poor compliance with these recommendations, with a median of 3 days prior to vascular access (VA) salvage. We present our initial results following the implementation of a clinical practice improvement programme (CPIP) to reduce delay to VA salvage.

Methods: The CPIP was conducted in three phases: pre-CPIP (23 January to 30 April 2023), CPIP pre-intervention (22 May to 3 September 2023) and CPIP post-intervention (4 September 2023 to 7 January 2024). Root cause analysis was performed to identify factors resulting in VA salvage delay. Measures implemented included a platform for multidisciplinary communication on cases requiring VA salvage, implementation of a structured workflow and regular reminders to ensure compliance. Early salvage was defined as <48 hours from triage at the emergency department. Time from admission to VA salvage, length of stay, incidence of femoral catheter (FC) insertion and overall cost savings were collected.

Results: There were 82 patients (90.1%) who received VA salvage during the CPIP period. The median age was 67 years with a male predominance (64%). There were 45 patients (54.9%) who received early VA salvage during CPIP. The run chart showed a median early VA salvage rate of 6.1% for pre-intervention and 81.0% for post-intervention. The median length of stay pre-intervention and post-intervention was 5.65 days and 2.92 days, respectively. The incidence of FC insertion was 17.1% (n=6/35) during CPIP for thrombosed VA. Eight patients failed to obtain early VA salvage during the post-intervention period. Overall hospitalisation cost savings per patient were SGD$3144 lower post-intervention.

Conclusion: We report the successful implementation of our CPIP through the involvement of stakeholders and stepwise implementation of measures using a structured protocol.

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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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