Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
复制标题
临床决策支持可改善急诊室静脉注射抗生素之前的血培养收集。
DOI：
10.1093/jamia/ocac115
复制
发表时间：
2022
期刊：
影响因子：
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通讯作者：
Rhee,Chanu
中科院分区：
文献类型：
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作者：
Dutta,Sayon;McEvoy,DustinS;Rubins,DavidM;Dighe,AnandS;Filbin,MichaelR;Rhee,Chanu
败血症生存指南建议败血症患者或中高危菌血症患者在静脉注射（IV）抗生素前进行血培养。临床决策支持（CDS），提醒急诊科（艾德）供应商获得血培养时，订购IV抗生素可能会导致改善这一过程measure.MethodsThis是一个多中心的因果影响分析比较及时的血培养收集之前，IV抗生素的成人艾德患者1年之前和之后的CDS干预实施的电子健康记录。贝叶斯结构的时间序列模型比较每日及时收集的血培养相比，预测的合成控制。混合效应模型评估的影响，干预控制confers.ResultsThe分析包括54 538例患者超过2年。 在基线阶段，46.1%的患者在静脉注射抗生素前进行了血培养，而干预后为58.8%。因果影响分析确定总体上及时血培养采集的绝对增加了13.1%（95% CI 10.4-15.7%），尽管脓毒症诊断或符合CDC成人脓毒症事件标准的患者之间的差异不显著，绝对差异为8.0%（95% CI −0.2至15.8）。血培养阳性增加在干预阶段，污染率在两个研究phases.DiscussionCDS提高静脉注射抗生素前收集血培养在艾德，而不增加overutilization.ConclusionA简单的CDS警报增加及时血培养收集艾德患者的感染的关注是足够高，以保证静脉注射抗生素。
ObjectiveSurviving Sepsis guidelines recommend blood cultures before administration of intravenous (IV) antibiotics for patients with sepsis or moderate to high risk of bacteremia. Clinical decision support (CDS) that reminds emergency department (ED) providers to obtain blood cultures when ordering IV antibiotics may lead to improvements in this process measure.MethodsThis was a multicenter causal impact analysis comparing timely blood culture collections prior to IV antibiotics for adult ED patients 1 year before and after a CDS intervention implementation in the electronic health record. A Bayesian structured time-series model compared daily timely blood cultures collected compared to a forecasted synthetic control. Mixed effects models evaluated the impact of the intervention controlling for confounders.ResultsThe analysis included 54 538 patients over 2 years. In the baseline phase, 46.1% had blood cultures prior to IV antibiotics, compared to 58.8% after the intervention. Causal impact analysis determined an absolute increase of 13.1% (95% CI 10.4–15.7%) of timely blood culture collections overall, although the difference in patients with a sepsis diagnosis or who met CDC Adult Sepsis Event criteria was not significant, absolute difference 8.0% (95% CI −0.2 to 15.8). Blood culture positivity increased in the intervention phase, and contamination rates were similar in both study phases.DiscussionCDS improved blood culture collection before IV antibiotics in the ED, without increasing overutilization.ConclusionA simple CDS alert increased timely blood culture collections in ED patients for whom concern for infection was high enough to warrant IV antibiotics.