Reducing Variability in the Infant Sepsis Evaluation (REVISE): A National Quality Initiative
Reducing Variability in the Infant Sepsis Evaluation (REVISE): A National Quality Initiative
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DOI：
10.1542/peds.2018-2201
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发表时间：
2019-09-01
期刊：
影响因子：
8
通讯作者：
Ralston, Shawn L.
中科院分区：
文献类型：
--
作者：
Biondi, Eric A.;McCulloh, Russell;Ralston, Shawn L.
一项国家质量倡议改善了发热、外观良好的婴儿管理关键方面的护理。背景：对发热但外观良好的婴儿的护理存在很大差异。我们的目的是评估国家质量倡议对该人群适当住院和住院时间 (LOS) 的影响。 方法：该倡议题为“减少婴儿脓毒症评估的变异性”(REVISE)，旨在标准化对 7 至 60 天、在没有明显来源的情况下进行发热评估的良好婴儿的护理。从急诊科和住院部收集了 12 个月的基线数据和 12 个月的实施数据。外观不佳的婴儿和患有合并症的婴儿被排除在外。参与站点收到了变更工具、运行图表、移动应用程序、实时网络研讨会、辅导和列表服务。通过统计过程控制图和中断时间序列回归进行分析。 2 个结果指标是接受适当评估并住院的住院婴儿的百分比以及以适当 LOS 出院的住院婴儿的百分比。 结果：总共，来自 38 个州的 124 家医院提供了 20570 名婴儿的数据。接受适当评估和住院的婴儿百分比以及具有适当 LOS 的婴儿百分比的中位点改善分别为 5.3%（四分位距 = -2.5% 至 13.7%）和 15.5%（四分位距 = 2.9 至 31.3）。两项措施都确定了目标的特殊原因变化。延迟治疗或漏诊细菌感染没有变化（斜率差 0.1；95% 置信区间，-8.3 至 9.1）。 结论：减少婴儿脓毒症评估的变异性表明婴儿发热管理的关键方面有所改善。类似的项目可用于改善其他临床条件的护理。
A national quality initiative improved care in key aspects of febrile, well-appearing infant management. BACKGROUND:Substantial variability exists in the care of febrile, well-appearing infants. We aimed to assess the impact of a national quality initiative on appropriate hospitalization and length of stay (LOS) in this population.METHODS:The initiative, entitled Reducing Variability in the Infant Sepsis Evaluation (REVISE), was designed to standardize care for well-appearing infants ages 7 to 60 days evaluated for fever without an obvious source. Twelve months of baseline and 12 months of implementation data were collected from emergency departments and inpatient units. Ill-appearing infants and those with comorbid conditions were excluded. Participating sites received change tools, run charts, a mobile application, live webinars, coaching, and a LISTSERV. Analyses were performed via statistical process control charts and interrupted time series regression. The 2 outcome measures were the percentage of hospitalized infants who were evaluated and hospitalized appropriately and the percentage of hospitalized infants who were discharged with an appropriate LOS.RESULTS:In total, 124 hospitals from 38 states provided data on 20570 infants. The median site improvement in percentages of infants who were evaluated and hospitalized appropriately and in those with appropriate LOS was 5.3% (interquartile range = -2.5% to 13.7%) and 15.5% (interquartile range = 2.9 to 31.3), respectively. Special cause variation toward the target was identified for both measures. There was no change in delayed treatment or missed bacterial infections (slope difference 0.1; 95% confidence interval, -8.3 to 9.1).CONCLUSIONS:Reducing Variability in the Infant Sepsis Evaluation noted improvement in key aspects of febrile infant management. Similar projects may be used to improve care in other clinical conditions.