新生儿高胆红素血症的过度诊断:质量改进基础的自然实验。

IF 1.2 Q3 PEDIATRICS
Kara J Stirling, Joseph W Kaempf, Lian Wang, Veronica I Luzzi, John V McDonald
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引用次数: 0

摘要

两家医院注意到新生儿高胆红素血症的增加与未公开的总血清胆红素(TSB)测定变化相一致。临床医生迅速应用质量改进方法来确定增加的黄疸评估、再入院和可能的安全问题。方法:2020年1月,A、B两家医院改用新型临床化学分析仪(西门子Atellica CH)检测TSB,由原来的重氮法改为钒酸氧化酶法。5家附属医院(C-G)继续使用重氮测定法。这个自然实验对7家医院的数据进行了比较。我们分析:(1)TSB水平,(2)医院高胆红素血症再入院,(3)配对TSB测量比较重氮法和钒酸盐氧化酶法。结果:与2019年基线相比,A、B医院2020年TSBs≥17.0 mg/dl和TSBs≥20 mg/dl显著增加;C-G医院没有。与2019年相比,2020年A医院和B医院再次接受光疗的人数显著增加。与重氮法相比,钒酸盐法的配对血液样本显示TSBs偏高。到2021年,该实验室恢复通过重氮分析处理TSB样本,TSB升高和高胆红素血症再入院的频率恢复到2019年的水平。结论:人为TSB升高与测定变化相关,显著增加新生儿高胆红素血症评估和光疗再入院率。嵌入的质量改进方法的仔细结构,过程和结果审查加速解决。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Overdiagnosis of Newborn Hyperbilirubinemia: A Natural Experiment in Quality Improvement Fundamentals.

Overdiagnosis of Newborn Hyperbilirubinemia: A Natural Experiment in Quality Improvement Fundamentals.

Two hospitals noted increased newborn hyperbilirubinemia coinciding with an undisclosed total serum bilirubin (TSB) assay change. Clinicians rapidly applied quality improvement methodologies to ascertain increased jaundice evaluations, readmissions, and possible safety issues.

Methods: In January 2020, 2 hospitals (A and B) transitioned to a new method of measuring TSB using a new clinical chemistry analyzer (Siemens Atellica CH), which measured TSB by vanadate oxidase assay instead of the previous diazo assay. Five affiliated hospitals (C-G) continued to utilize the diazo assay. This natural experiment led to a comparison of data across the 7 hospitals. We analyzed: (1) TSB levels, (2) hospital hyperbilirubinemia readmissions, and (3) paired TSB measurements comparing the diazo assay and vanadate oxidase method.

Results: Compared to the 2019 baseline, Hospitals A and B had a significant increase in TSBs ≥17.0 mg/dl and TSBs ≥20 mg/dl in 2020; Hospitals C-G did not. Readmissions for phototherapy significantly increased in hospitals A and B in 2020 compared to 2019. Paired blood samples showed bias-elevated TSBs by vanadate assay compared to the diazo method. By 2021, the laboratory resumed processing TSB samples by diazo assay, and the frequency of elevated TSBs and hyperbilirubinemia readmissions returned to 2019 levels.

Conclusions: Factitious TSB elevation related to an assay change significantly increased newborn hyperbilirubinemia evaluations and phototherapy readmissions. Imbedded quality improvement methodologies of careful structure, process, and outcomes review hastened resolution.

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来源期刊
CiteScore
2.20
自引率
0.00%
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0
审稿时长
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