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1.
Postgrad Med J ; 94(1118): 716-719, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30670487

RESUMO

INTRODUCTION: The Choosing Wisely guidelines advise against ordering routine blood tests for hospitalised patients unless they change management. Unnecessary testing can lead to adverse effects (eg, iatrogenic anaemia, poor sleep quality, risk for infections and increased cost of care). METHODS: An 8-week quality initiative aimed at reducing unnecessary blood tests was implemented in three internal medicine resident inpatient services. The initiative included a 30 min educational session, reminders prior to rotation and midrotation and posters in work areas that displayed lab pricing and urged judicious testing. Residents were encouraged to justify the purpose of ordering tests in their daily progress notes. Attending physicians were made aware of the initiative. Preintervention and postintervention time points were used to compare key metrics. A >10% decrease between time periods was used as an evaluation criterion. RESULTS: There were 293 patient records reviewed in the preintervention period and 419 in the postintervention period. The two groups were similar in terms of age and gender. Median blood test count (complete blood count/basic metabolic profile/comprehensive metabolic profile) decreased from 4 to 2 tests per patient per day (50 % decrease) after the intervention. The median length of hospital stay decreased from 4.9 to 3.9 days (21% decrease). A decreased percentage of people requiring transfusions was also noted (2016: 6.1%, 2017: 2.9%). CONCLUSION: The frequency of unnecessary routine blood tests ordered in the hospital can be decreased by educating resident physicians, making them cost conscious and aware of the indications for ordering routine labs. Frequent reminders are needed to sustain the educational benefit.


Assuntos
Testes Diagnósticos de Rotina/normas , Medicina Interna/educação , Internato e Residência , Melhoria de Qualidade , Procedimentos Desnecessários/estatística & dados numéricos , Idoso , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Tomada de Decisões , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Michigan , Pessoa de Meia-Idade
2.
BMJ Qual Saf ; 26(5): 372-380, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-27154878

RESUMO

BACKGROUND: Clinical summaries are electronic health record (EHR)-generated documents given to hospitalised patients during the discharge process to review their hospital stays and inform postdischarge care. Presently, it is unclear whether clinical summaries include relevant content or whether healthcare organisations configure their EHRs to generate content in a way that promotes patient self-management after hospital discharge. We assessed clinical summaries in three relevant domains: (1) content; (2) organisation; and (3) readability, understandability and actionability. METHODS: Two authors performed independent retrospective chart reviews of 100 clinical summaries generated at two Michigan hospitals using different EHR vendors for patients discharged 1 April -30 June 2014. We developed an audit tool based on the Meaningful Use view-download-transmit objective and the Society of Hospital Medicine Discharge Checklist (content); the Institute of Medicine recommendations for distributing easy-to-understand print material (organisation); and five readability formulas and the Patient Education Materials Assessment Tool (readability, understandability and actionability). RESULTS: Clinical summaries averaged six pages (range 3-12). Several content elements were universally auto-populated into clinical summaries (eg, medication lists); others were not (eg, care team). Eighty-five per cent of clinical summaries contained discharge instructions, more often generated from third-party sources than manually entered by clinicians. Clinical summaries contained an average of 14 unique messages, including non-clinical elements irrelevant to postdischarge care. Medication list organisation reflected reconciliation mandates, and dosing charts, when present, did not carry column headings over to subsequent pages. Summaries were written at the 8th-12th grade reading level and scored poorly on assessments of understandability and actionability. Inter-rater reliability was strong for most elements in our audit tool. CONCLUSIONS: Our study highlights opportunities to improve clinical summaries for guiding patients' postdischarge care.


Assuntos
Compreensão , Sumários de Alta do Paciente Hospitalar/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Registros Eletrônicos de Saúde , Feminino , Hospitais , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Alta do Paciente , Projetos Piloto , Estudos Retrospectivos , Adulto Jovem
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