Oral antibiotics at discharge for children with acute osteomyelitis: a rapid cycle improvement project.
Oral antibiotics at discharge for children with acute osteomyelitis: a rapid cycle improvement project.
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DOI：
10.1136/bmjqs-2013-002179
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发表时间：
2014-06
影响因子：
5.4
通讯作者：
Vossmeyer MT
中科院分区：
文献类型：
--
作者：
Brady PW;Brinkman WB;Simmons JM;Yau C;White CM;Kirkendall ES;Schaffzin JK;Conway PH;Vossmeyer MT
大量证据表明，口服与静脉治疗常规骨髓炎的治愈率相当。证据的采纳通常是缓慢的，在我们的中心，几乎所有的骨髓炎患者都接受静脉治疗。至于因急性骨髓炎而入住医院内科的病人，我们的目标是把使用口服抗生素而出院的病人比例提高至最少70%。我们的观察性时间序列研究的背景是一家大型学术儿童医院。改进模型和计划-实施-研究-行动循环被用于测试、改进和实施通过我们的关键驱动图确定的干预措施。我们的多方面干预包括共享决策工具，电子健康记录中的订单，以及对教师和学员的教育。我们还纳入了近实时识别和缓解干预措施，以针对照顾骨髓炎儿童的目标提供者，并加强基于证据的建议。数据分析了一个注释的g-图表骨髓炎病例之间的病人出院静脉注射抗生素。结构化图表审查用于识别干预前和干预后组的治疗失败以及住院时间和住院费用。在我们发现并减轻干预后，出院后接受静脉注射抗生素的患者之间的骨髓炎病例从干预前的中位数0例增加到最多9例。观察到的连续改善的方向和幅度满足特殊原因变异的标准。改善已持续1年。治疗失败和并发症是罕见的干预前和干预后阶段。在住院时间或费用方面没有发现显著差异。即使对于不常见的情况，使用质量改进方法也可以快速和持续地采用证据。
Substantial evidence demonstrates comparable cure rates for oral versus intravenous therapy for routine osteomyelitis. Evidence adoption is often slow and in our centre virtually all patients with osteomyelitis were discharged on intravenous therapy. For patients with acute osteomyelitis admitted to the hospital medicine service, we aimed to increase the proportion of cases discharged on oral antibiotics to at least 70%. The setting for our observational time series study was a large academic children’s hospital. The model for improvement and plan-do-study-act cycles were used to test, refine and implement interventions identified through our key driver diagram. Our multifaceted intervention included a shared decision-making tool, an order set in our electronic health record, and education to faculty and trainees. We also included an identify and mitigate intervention to target providers caring for children with osteomyelitis in near-real time and reinforce the evidence-based recommendations. Data were analysed on an annotated g-chart of osteomyelitis cases between patients discharged on intravenous antibiotics. Structured chart review was used to identify treatment failures as well as length of stay and hospital charges in preintervention and postintervention groups. The osteomyelitis cases between patients discharged on intravenous antibiotics increased from a median of 0 preintervention to a maximum of 9 cases following our identify and mitigate intervention. The direction and magnitude of successive improvements observed satisfied criteria for special cause variation. Improvement has been sustained for 1 year. Treatment failure and complications were uncommon in preintervention and postintervention phases. No significant differences in length of stay or charges were detected. Even for uncommon conditions, rapid and sustained evidence adoption is possible using quality improvement methods.
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影响因子：
2.6
作者：
Gutierrez, K
通讯作者：
Gutierrez, K
影响因子：
11.8
作者：
Jenkins, Timothy C.;Price, Connie S.;Burman, William J.
通讯作者：
Burman, William J.
影响因子：
8
作者：
Ambroggio, Lilliam;Thomson, Joanna;White, Christine M.
通讯作者：
White, Christine M.
影响因子：
8
作者：
Jerardi, E.;Elkeeb, Dena;Brinkman, William B.
通讯作者：
Brinkman, William B.
影响因子：
3.7
作者：
Le Saux, N;Howard, A;Moher, D
通讯作者：
Moher, D