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首页> 外文期刊>Canadian Journal of Emergency Medicine >LO14: Interdepartmental program to improve outcomes for acute heart failure patients seen in the emergency department
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LO14: Interdepartmental program to improve outcomes for acute heart failure patients seen in the emergency department

机译：LO14：用于改善急性心力衰竭患者在急诊部门的急性心力衰竭患者的延期计划

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Introduction: An important challenge physicians face when treating acute heart failure (AHF) patients in the emergency department (ED) is deciding whether to admit or discharge, with or without early follow-up. The overall goal of our project was to improve care for AHF patients seen in the ED while avoiding unnecessary hospital admissions. The specific goal was to introduce hospital rapid referral clinics to ensure AHF patients were seen within 7 days of ED discharge. Methods: This prospective before-after study was conducted at two campuses of a large tertiary care hospital, including the EDs and specialty outpatient clinics. We enrolled AHF patients ≥50 years who presented to the ED with shortness of breath (<7 days). The 12-month before (control) period was separated from the 12-month after (intervention) period by a 3-month implementation period. Implementation included creation of rapid access AHF clinics staffed by cardiology and internal medicine, and development of referral procedures. There was extensive in-servicing of all ED staff. The primary outcome measure was hospital admission at the index visit or within 30 days. Secondary outcomes included mortality and actual access to rapid follow-up. We used segmented autoregression analysis of the monthly proportions to determine whether there was a change in admissions coinciding with the introduction of the intervention and estimated a sample size of 700 patients. Results: The patients in the before period (N?=?355) and the after period (N?=?374) were similar for age (77.8 vs. 78.1 years), arrival by ambulance (48.7% vs 51.1%), comorbidities, current medications, and need for non-invasive ventilation (10.4% vs. 6.7%). Comparing the before to the after periods, we observed a decrease in hospital admissions on index visit (from 57.7% to 42.0%; P <0.01), as well as all admissions within 30 days (from 65.1% to 53.5% (P?
机译：介绍：在治疗急性心力衰竭（AHF）急诊部门（ED）患者时，重要的挑战医生面临的是决定是否承认或卸下，有或没有提前随访。我们项目的总体目标是改善ED中看到的AHF患者的护理，同时避免不必要的医院入学。具体目标是引入医院的快速转诊诊所，以确保在ED放电的7天内看到AHF患者。方法：在大型高等教育医院的两家校区进行这项前瞻性研究，包括EDS和专业门诊诊所。我们注册了AHF患者≥50岁，呼吸呼吸短促（<7天）。之前（控制）期间的12个月与3个月实施期间（干预）期间分开。实施包括由心脏病学和内科的快速访问AHF诊所的创建，以及推荐程序的发展。所有ED员工都有广泛的服务。主要成果措施是在指数访问或30天内入院入院。二次结果包括死亡率和实际访问快速随访。我们使用分割的自动评论分析每月比例，以确定是否在引入干预和估计700名患者的样本大小重合录取的录取。结果：患者在前期（n？= 355）和后期（n？= 374）的年龄（77.8与78.1岁），救护车抵达（48.7％vs 51.1％），合并症，目前的药物，需要进行非侵入性通气（10.4％vs.6.7％）。比较前期的后期，我们观察到了对指数访问的医院入学减少（从57.7％到42.0％; P <0.01），以及30天内的所有入院（从65.1％到53.5％（P？< ？0.01）。但是，自回归分析展示了较少的招生趋势，并且不能将这一点归因于干预（P？= 0.91）。出席特种诊所，其中排放量增加到42.1 ％（p？<0.01）和诊所的中位数从13〜6天降低（p？<0.01）。30天死亡率没有变化（4.5％与4.0％; p？= 0.76）。结论：迅速进入专用AHF诊所的实施导致了对专业护理的机会大大增加，减少了后续时间，也可能减少医院入学。广泛使用这种方法可以改善加拿大的AHF护理。

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