USE OF A GUIDELINE BASED QUESTIONNAIRE TO AUDIT HOSPITAL-CARE OF ACUTE ASTHMA
USE OF A GUIDELINE BASED QUESTIONNAIRE TO AUDIT HOSPITAL-CARE OF ACUTE ASTHMA
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DOI：
10.1136/bmj.302.6790.1440
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发表时间：
1991-06-15
影响因子：
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通讯作者：
GABBAY, J
中科院分区：
文献类型：
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作者：
BELL, D;LAYTON, AJ;GABBAY, J
目的：设计一份审计问卷，并由一名审计助理试用，以监测急性哮喘住院病人的管理情况，并比较胸科医生和普通医生的护理情况。设计：由一名胸科医生和审计助理对随机抽样的76例患者病例记录进行回顾性分析，采用基于标准的问卷调查，问卷调查来源于医院急性哮喘管理指南。环境-一所地区综合医院。患者——76名患有急性哮喘的成年患者：38人在1988年4月至1989年3月期间因相关的初步诊断入院，另有38人在1989年4月至1990年3月期间通过事故和急诊科入院。主要结果测量指标-是否符合审核前后胸科医生和普通科医生评估和管理急性哮喘的公认标准。结果：不同组患者的年龄和性别没有显著差异。总体而言，与指南的偏差发生在哮喘严重程度的记录、β -2激动剂（60/ 76,79%）和类固醇（43/ 76,57%）的紧急治疗以及至少符合指南一项标准的抗生素处方（29/ 45,64%）。胸科医生在记录严重程度指标方面比普通医生更严格，尤其是血清钾浓度（chi-2 = 3.6, df = 1, p = 0.06）、正确时间内的紧急类固醇治疗（chi-2 = 3.9, df = 1, p = 0.05）、转到门诊胸科诊所随访。动脉血气张力的记录在1988-9年和1989-90年之间显著改善（chi-2 = 7.0, df = 1, p = 0.08）。结论：该问卷对医生和审计助理都易于使用。审计工作几乎没有改进护理标准，并强调需要进一步加强和反馈。
Objectives - To design an audit questionnaire and pilot its use by an audit assistant to monitor inpatient management of acute asthma and to compare the care given by chest physicians and general physicians.Design - Retrospective review by a chest physician and audit assistant of a random sample of 76 case records of patients by a criterion based questionnaire developed from hospital guidelines on management of acute asthma.Setting - One district general hospital.Patients - 76 adult patients with acute asthma: 38 admitted with a relevant primary diagnosis between April 1988 and March 1989 and a further 38 admitted through the accident and emergency department between April 1989 and March 1990.Main outcome measures - Conformity with recognised standards for assessment and management of acute asthma before and after the audit and by chest physicians and general physicians.Results - Age and sex did not differ significantly between the different groups of patients. Overall, deviations from the guidelines occurred in recording measures of severity of asthma, emergency treatment with beta-2 agonists (60/76, 79%) and steroids (43/76, 57%), and prescription of antibiotics in accordance with at least one criterion of the guidelines (29/45, 64%). Chest physicians were more rigorous than general physicians in recording severity measures, especially serum potassium concentration (chi-2 = 3.6, df = 1, p = 0.06), emergency steroid treatment within the correct period (chi-2 = 3.9, df = 1, p = 0.05), and referral for follow up at an outpatient chest clinic. Recording of arterial blood gas tensions improved significantly between the 1988-9 and 1989-90 samples (chi-2 = 7.0, df = 1, p = 0.08).Conclusions - The questionnaire proved easy to use for both doctor and audit assistant. The audit improved few standards of care and emphasises the need for further reinforcement and feedback.