Fever Evaluation Cost and Time to Treatment in the General Surgery Patient Can be Reduced by Using a Fever Practice Guideline
Fever Evaluation Cost and Time to Treatment in the General Surgery Patient Can be Reduced by Using a Fever Practice Guideline
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DOI：
10.7205/milmed-d-13-00354
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发表时间：
2014-09-01
影响因子：
1.2
通讯作者：
Hannon, Matthew
中科院分区：
文献类型：
--
作者：
Russo, Paul R.;Landon, Matthew;Hannon, Matthew
目的：对发热和白细胞增多 (FAL) 的手术患者进行感染源评估通常会导致不必要的实验室和放射学检查。 FAL 后处理的平均成本从 2200 美元到 5600 美元不等。缺乏系统的方法导致成本高于必要的水平。我们评估了使用常规 FAL 检查方法与使用既定发烧实践指南 (FPG) 进行 FAL 检查在治疗时间和费用方面的差异。方法：在第一阶段，对 82 名接受 FAL 检查的成人手术患者进行了回顾性电子图表审查，以确定从初始体温出现到发烧治疗的时间以及每次发烧评估的总费用。在第二阶段，使用第一阶段数据点，将既定的 FPG 应用到最初 82 名重症监护病房患者中的 30 名患者。使用配对 t 检验比较治疗费用和时间的差异。结果：发烧治疗的平均时间从使用 FPG 前的 51.57 小时减少到使用后的 11.23 小时 (p < 0.001)，到最终治疗的时间缩短了 78%。 FAL 后处理的平均成本从不使用 FPG 的 1,009.73 美元降至 399.00 美元，成本降低了 60%。结论：使用标准化 FPG，可以显着减少 FAL 治疗的检查时间和费用。
Objectives: Evaluation of surgical patients with fever and leukocytosis (FAL) for an infection source often results in unnecessary laboratory and radiographic tests. The average cost of an FAL work-up ranges from $2200 to $5600. Lack of a systematic approach drives costs higher than necessary. We evaluated differences in time to treatment and costs using usual methods of FAL work-ups versus FAL work-ups using an established fever practice guideline (FPG). Methods: In phase I, a retrospective electronic chart review was conducted for 82 adult surgery patients who underwent FAL work-ups to determine time from initial temperature presentation to fever treatment and total cost per fever evaluation. In phase II, an established FPG was applied to 30 intensive care unit patients from the original group of 82 using phase I data points. Differences in cost and time to treatment were compared using a paired t-test. Results: Mean time to fever treatment decreased from 51.57 hours pre-FPG use to 11.23 hours afterward (p < 0.001), a 78% reduction in time to definitive treatment. Mean cost of FAL work-up decreased from $1,009.73 without FPG use to $399.00 with a 60% reduction in costs. Conclusions: Using a standardized FPG, FAL work-up time to treatment and cost can be significantly reduced.