Evidence-Based Care Pathway for Cellulitis Improves Process, Clinical, and Cost Outcomes
Evidence-Based Care Pathway for Cellulitis Improves Process, Clinical, and Cost Outcomes
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DOI：
10.1002/jhm.2433
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发表时间：
2015-12-01
影响因子：
2.6
通讯作者：
Kawamoto, Kensaku
中科院分区：
文献类型：
--
作者：
Yarbrough, Peter M.;Kukhareva, Polina V.;Kawamoto, Kensaku
背景：蜂窝织炎是一种常见的感染，临床护理差异很大。目的：实施循证护理途径，评估蜂窝织炎过程指标、临床结果和成本的变化。设计：进行回顾性观察性干预前/干预后研究。环境：犹他大学医疗保健中心（University of Utah Health Care）是犹他州盐湖城一个拥有500张床位的学术医疗中心。患者：所有18岁或以上的患者，以蜂窝织炎的初步诊断住进急诊科观察室或医院。干预：发展蜂窝织炎循证护理途径，并将其纳入所有急诊和内科医生的电子病历教育中。测量：广谱抗生素使用的主要结局。次要结果为计算机断层扫描/磁共振成像订单、住院时间（LOS）、30天再入院、药房、实验室、成像和总设施费用。结果：共进行了677次就诊，其中370次就诊使用了订单集。在所有患者中，订购广谱抗生素的几率降低了59% (P < 0.001)，药房成本降低了23% (P = 0.002)，总设施成本降低了13% （P = 0.006）。与未使用处方集的患者相比，使用处方集的患者在订购广谱抗生素的几率（P < 0.001）、临床LOS （P = 0.041）和药房费用（P = 0.074）方面分别降低了75%、13%和25%。结论：基于证据的蜂窝织炎护理途径通过减少广谱抗生素使用、药房费用和总设施费用而改善了学术医疗中心的护理，而LOS或30天再入院没有不良变化。(C) 2015年医院医学学会
BACKGROUND: Cellulitis is a common infection with wide variation of clinical care.OBJECTIVE: To implement an evidence-based care pathway and evaluate changes in process metrics, clinical outcomes, and cost for cellulitis.DESIGN: A retrospective observational pre-/postintervention study was performed.SETTING: University of Utah Health Care, a 500-bed academic medical center in Salt Lake City, Utah.PATIENTS: All patients 18 years or older admitted to the emergency department observation unit or hospital with a primary diagnosis of cellulitis.INTERVENTION: Development of an evidence-based care pathway for cellulitis embedded into the electronic medical record with education for all emergency and internal medicine physicians.MEASUREMENTS: Primary outcome of broad-spectrum antibiotic use. Secondary outcomes of computed tomography/magnetic resonance imaging orders, length of stay (LOS), 30-day readmission, and pharmacy, lab, imaging, and total facility costs.RESULTS: A total of 677 visits occurred, including 370 visits where order sets were used. Among all patients, there was a 59% decrease in the odds of ordering broad-spectrum antibiotics (P < 0.001), 23% decrease in pharmacy cost (P = 0.002), and 13% decrease in total facility cost (P = 0.006). Compared to patients for whom order sets were not used, patients for whom order sets were used had a 75%, 13%, and 25% greater decrease in the odds of ordering broad-spectrum antibiotics (P < 0.001), clinical LOS (P = 0.041), and pharmacy costs (P = 0.074), respectively.CONCLUSION: The evidence-based care pathway for cellulitis improved care at an academic medical center by reducing broad-spectrum antibiotic use, pharmacy costs, and total facility costs without an adverse change in LOS or 30-day readmissions. (C) 2015 Society of Hospital Medicine