RESUMO
Prescribing intravenous fluids in a hospital setting is a task that each clinician has to endorse in an everyday practice. This task is universal to the point that it is often undervalued, or even neglected during clinical teaching. However, one shouldn't underestimate the risks related to excessive fluid administration, of which the clinician often doesn't know the exact composition. Literature about persistent fluid overload in hospital is scarce. This complex condition should however be given the attention it deserves. Indeed, it seems to be associated with increased costs and an excess in morbidity and even mortality.
La prescription des solutions hydroélectrolytiques est une tâche dont tout médecin clinicien en milieu hospitalier doit s'acquitter. Cette tâche est à tel point universelle qu'elle est malheureusement souvent banalisée, voire négligée au cours de l'enseignement clinique. Pourtant, on ne saurait sous-estimer les risques associés à une administration excessive de solutions dont le contenu précis est souvent mal connu du prescripteur. Même si la littérature sur le sujet de l'hypervolémie persistante à l'hôpital est rare, celle-ci est associée à une augmentation des coûts et à un excès de morbidité, voire de mortalité.
Assuntos
Hidratação , Humanos , Infusões Intravenosas , Pacientes InternadosRESUMO
BACKGROUND: Reducing unnecessary laboratory blood testing in the hospital setting represents a challenge to improve the adequacy of healthcare and a tricky task for teaching hospitals. Our hospital network actively participates in the Choosing Wisely Campaign and is engaged in avoiding unnecessary low value interventions and investigations. We aimed to study whether a multi-level approach combining educational and web-system based interventions, could be effective in reducing laboratory testing and related costs. METHODS: Multicenter, proof of concept, prospective, observational, before and after study, in a network of public hospitals in Switzerland. All patients admitted between 1 January 2015 and 31 December 2017 were analyzed. A multi-level strategy based on online continuous monitor benchmarking and educational support was applied in the internal medicine services. The primary outcome was a significant reduction in the number of laboratory tests per patient and per day during the hospital stay. Secondary outcomes were reduction in the blood sample volume taken per patient and per day in laboratory costs. RESULTS: Over the 36 months of the study, 33 309 admissions were analyzed. A significant reduction of laboratory tests per patient and per day of hospitalisation was found:-11%, P-value<0.001; -6%, P-value <0.001. The mean monthly blood volume, per patient and per day of hospital stay and laboratory costs per patient was also significantly reduced: -7%, P-value<0.05; -3%, P-value<0.01, and -17%, P-value<0.01, respectively. CONCLUSIONS: The obtained reduction in the number of laboratory tests, blood volume withdrawn and related costs, support the idea that an open web-based system, involving all health care providers, coupled with educational interventions, can be helpful in generating awareness of prescriber habits and to catalyze changes in their behaviour. The peer pressure related to the unmasked benchmarking process did probably play a determinant role.