减少血液培养病原体鉴定的实验室延误:一项质量改进工程。

IF 1.3 Q4 HEALTH CARE SCIENCES & SERVICES
Fenella D Halstead, Goran Pinjuh, Grazia Antonacci, Nathan Proudlove
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引用次数: 0

摘要

脓毒症是一种由血液中的细菌和免疫反应失调引起的医疗紧急情况。重要的是迅速识别细菌,以便患者接受有效的抗生素治疗。延迟治疗与较高的死亡率和较差的临床结果有关。指南要求使用旧技术在48小时内,使用现代平台在24小时内,从标记为阳性的瓶子进行完整的细菌鉴定(ID)。在这个质量改进项目之前,我们使用的是旧技术,包括分析特征指数(API)生化测试。分析强调了非常差的性能(平均60小时到ID),导致有限的临床效用和临床事故。实验室和临床工作人员感到非常沮丧。本项目旨在缩短血培养阳性获得ID的时间,在6个月内达到指导要求。分析导致了一个商业案例,帮助确保了新设备的资金:矩阵辅助激光解吸电离(MALDI)平台,以取代耗时的API过程。MALDI使用飞行时间质谱法在几分钟内间接(从琼脂平板菌落)或直接从血液中产生快速的细菌ID。MALDI是通过两个计划-执行-研究-行动周期引入的,首先是间接分析,然后是直接分析。这就分散了科学人员培训的负担。新工艺大大缩短了从标记到病原体ID的平均时间,平均为10.2小时,24小时内ID的可用性从0%提高到95%。我们确定了其他改进的改变想法(增加员工可用性和后期阶段的新技术),但由于时间和资金压力,这些想法被搁置了。尽管仍然存在局限性(特别是在人员工作时间和ID结果的后续沟通方面),MALDI平台已经彻底改变了我们可以提供的败血症服务,因此代表了我们患者可以接受的护理质量的实质性提高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Reducing laboratory delays in blood culture pathogen identification: a quality improvement project.

Sepsis is a medical emergency caused by bacteria in the bloodstream and a dysregulated immune response. It is important to identify the bacteria rapidly so that the patient receives effective antibiotics. Delays are associated with higher mortality levels and poorer clinical outcomes.Guidance requires full bacterial identification (ID) from bottle flagging positive, within 48 hours with older technology and 24 hours with modern platforms. Before this quality improvement project, we were using old technology including Analytical Profile Index (API) biochemical tests. Analysis highlighted very poor performance (mean 60 hours to ID), resulting in limited clinical utility and clinical incidents. There was great frustration among laboratory and clinical staff.This project aimed to reduce the time taken to obtain ID for positive blood cultures to meet the guidance within 6 months. Analysis led to a business case which helped secure funding for new equipment: a Matrix Assisted Laser Desorption Ionisation (MALDI) platform, to replace the time-consuming API process. MALDI uses time-of-flight mass spectrometry producing rapid ID of bacteria in minutes, indirectly (from agar plate colonies) or directly from blood.MALDI was introduced through two Plan-Do-Study-Act cycles, first with indirect analysis, then with direct. This spread the scientific staff training burden. The new process has dramatically reduced the mean time from flagging to pathogen ID to an average of 10.2 hours, and availability of ID within 24 hours has improved from 0% to 95%.We identified other change ideas for improvement (increasing staff availability and new technology for later stages), but these were parked due to time and funding pressures.Although there remain limitations (especially in terms of staffing hours and the onward communication of the ID result), the MALDI platform has revolutionised the sepsis service we can provide, so represents a substantial improvement in the quality of care that our patients can receive.

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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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