Phlebotomy-free days in children hospitalized with common infections and their association with clinical outcomes.
Phlebotomy-free days in children hospitalized with common infections and their association with clinical outcomes.
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因常见感染住院的儿童的无静脉放血天数及其与临床结果的关系。
DOI：
10.1002/jhm.13282
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发表时间：
2024
影响因子：
2.6
通讯作者：
Markham,JessicaL
中科院分区：
文献类型：
--
作者：
Collins,MeganE;Hall,Matt;Shah,SamirS;Molloy,MatthewJ;Aronson,PaulL;Cotter,JillianM;Steiner,MichaelJ;McCoy,Elisha;Tchou,MichaelJ;Stephens,JohnR;Markham,JessicaL
背景对住院儿童进行静脉切开术具有后果（例如，疼痛、医源性贫血）和不必要的测试是医疗保健中可改变的浪费来源。无抽血天数或无静脉切开天数（PFDs）有可能作为医院质量指标。目的描述：（1）因常见感染住院的儿童中PFDs的频率和（2）PFDs与临床结果的相关性。设计，我们对2018年住院的儿童进行了一项横断面研究，2019年，使用儿科健康信息系统数据库在38家医院进行常见感染。我们纳入了感染性所有患者精细诊断相关组，中位住院时间（LOS）>2天。我们排除了具有医疗复杂性、医院间转移、接受重症监护和院内死亡率的患者。主要结果和测量我们将PFDs定义为没有实验室血液检测的住院天数（午夜至午夜），并测量了每种疾病和医院的PFDs除以总医院LOS的比例（PFD比率）。PFD比率越高，意味着不进行静脉切开术的天数越多。医院被分为低，中，高平均PFD比率。调整后的结果（LOS，成本和再入院）进行了比较groups.ResultsWe确定了126,135遭遇。细支气管炎（0.78）和肺炎（0.54）的PFD比率最高（大多数PFD），而骨关节感染（0.28）和胃肠炎（0.30）的PFD比率最低。PFD比率组之间的校正临床结局无差异。在因常见感染住院的儿童中，PFD比率因病情和医院而异，与结果无关。我们的数据表明过度使用静脉切开术和机会，以改善住院儿童的护理。
BackgroundPhlebotomy for hospitalized children has consequences (e.g., pain, iatrogenic anemia), and unnecessary testing is a modifiable source of waste in healthcare. Days without blood draws or phlebotomy‐free days (PFDs) has the potential to serve as a hospital quality measure.ObjectiveTo describe: (1) the frequency of PFDs in children hospitalized with common infections and (2) the association of PFDs with clinical outcomes.Design, Settings and ParticipantsWe performed a cross‐sectional study of children hospitalized 2018–2019 with common infections at 38 hospitals using the Pediatric Health Information System database. We included infectious All Patients Refined Diagnosis Related Groups with a median length of stay (LOS) >2 days. We excluded patients with medical complexity, interhospital transfers, those receiving intensive care, and in‐hospital mortality.Main Outcome and MeasuresWe defined PFDs as hospital days (midnight to midnight) without laboratory blood testing and measured the proportion of PFDs divided by total hospital LOS (PFD ratio) for each condition and hospital. Higher PFD ratios signify more days without phlebotomy. Hospitals were grouped into low, moderate, and high average PFD ratios. Adjusted outcomes (LOS, costs, and readmissions) were compared across groups.ResultsWe identified 126,135 encounters. Bronchiolitis (0.78) and pneumonia (0.54) had the highest PFD ratios (most PFDs), while osteoarticular infections (0.28) and gastroenteritis (0.30) had the lowest PFD ratios. There were no differences in adjusted clinical outcomes across PFD ratio groups. Among children hospitalized with common infections, PFD ratios varied across conditions and hospitals, with no association with outcomes. Our data suggest overuse of phlebotomy and opportunities to improve the care of hospitalized children.