改善儿科急诊室的咳嗽管理。

Postgraduate medicine Pub Date : 2024-05-01 Epub Date: 2024-05-31 DOI:10.1080/00325481.2024.2360889
Leman Akcan Yildiz, Halise Akca, Funda Kurt, Damla Hanalioglu, Meltem Cetin, Saliha Senel, Can Demir Karacan
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引用次数: 0

摘要

目的:在儿科急诊室(PED),过度检查和过度治疗在患有喉鸣的儿童中很常见。本研究的目的是改善对患儿的护理:在这项质量改进(QI)计划中,所有开始在儿科急诊科轮转的儿科住院医师都参加了关于大嗓门的信息讲座,并在整个轮转期间得到提醒。这项 QI 计划的主要成果是在 7 个月内将轻度喉鸣儿童的雾化肾上腺素 (NE) 使用量减少 50%。其他成果包括对所有患儿使用地塞米松,减少抗生素、实验室检查和复诊次数,缩短体格检查、地塞米松和NE治疗之间的间隔时间,以及在PED的住院时间(LOS):结果:轻度气团患者使用 NE 的比例从 80.2% 降至 36.3%(P P P > 0.05)。患者使用地塞米松的时间和住院时间明显缩短(P通过这一 QI 干预措施,轻度气团病例的 NE 用药率、抗生素处方、X 光检查、实验室血液和呼吸道 PCR 小组检测均有所下降,但复诊率并未增加。然而,不必要的新生儿营养素、抗生素和 X 光检查率仍然很高。
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Improving croup management at a pediatric emergency department.

Objectives: Over-testing and over-treatment are common in children with croup at pediatric emergency departments (PED). The objective of the study was to improve care for children with croup.

Methods: In this quality improvement (QI) initiative, all pediatric residents starting their rotation in the PED attended an informative presentation about croup and were provided reminders throughout their rotation. The primary outcome of this QI initiative was to reduce nebulized epinephrine (NE) use among children with mild croup by 50% over 7 months. The secondary outcome was to reduce X-rays by 50% over 7 months. Other outcomes included the administration of dexamethasone to all children with croup, reduction of antibiotics, laboratory tests, and revisits, and shortening the duration between physical examination to dexamethasone and NE treatments, and the length of stay (LOS) at the PED.

Results: NE administration to patients with mild croup decreased from 80.2% to 36.3% (p < 0.001). The proportion of children with X-rays decreased from 37.4% to 17.1% (p < 0.001). There was a significant increase in dexamethasone administration, and significant decreases in laboratory blood tests, expanded viral PCR panel tests, and antibiotic prescription among all croup cases (p < 0.001). Revisit rates were not significantly different (p > 0.05). Time to dexamethasone and LOS shortened significantly (p < 0.001).

Conclusion: With this QI intervention, decreases in the rate of administration of NE to mild croup cases, antibiotic prescription, X-ray, laboratory blood and respiratory PCR panel tests in all croup cases were achieved without an increase in revisits. However, unnecessary NE, antibiotic, and X-ray rates are still high.

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