减少检测，提高产出：多组分干预使住院生化检测减半

摘要(中文译文)

住院患者常规生化检查常在没有临床指征的情况下被重复进行。本质量改进项目旨在减少丹麦某心内科病房的低价值生化检查，目标是在6个月内减少5%，并维持12个月，同时不导致住院时间、中午后出院或30天再入院情况的不利变化。在该质量改进项目中，采用改进模型并通过计划-执行-研究-处理循环实施，多学科团队采取了以下干预措施：（i）针对医生和护士的定向教育，例如明确开单责任；（ii）优化默认生化组合，移除非必要项目（如白细胞计数及分类、尿素、血红蛋白），并遏制在最短复检间隔前提前开单；（III）设置集中反馈仪表板。主要结局是生化检查数量，并按住院小时数和病例量进行调整。次要结局是结果超出参考范围的比例以及常见生化检查的复检间隔。安全性平衡指标为住院时间、中午后出院和30天再入院。干预前阶段为2022年2月27日至2023年2月26日，干预后阶段为2023年3月5日至2025年2月2日。2023年6月优化生化组合后，生化检查中位数减少了54%（按住院小时数调整）和48%（按病例量调整）。检查结果超出参考范围的比例增加了21%。血红蛋白和肌钙蛋白-I的复检间隔延长。平衡指标未显示不利信号，且效果持续至2025年2月。一个务实、简单的干预组合使常规生化检查减半，并提高了诊断产出，且未造成可测量的损害。

Abstract

Routine inpatient biochemical testing is often repeated without clinical indication. This quality improvement project aimed to reduce low-value biochemical testing in a Danish cardiology ward, targeting a 5% reduction within 6 months and sustainment for 12 months, without adverse changes in length of stay, discharges after noon, or 30-day readmissions. In a quality improvement project using the Model for Improvement and conducted through Plan-Do-Study-Act cycles, a multidisciplinary team implemented the following interventions: (i)targeted education for physicians and nurses e.g. clarifying of ordering responsibility; (ii)refinement of default biochemical profiles by removing non-essential tests (e.g. leukocyte count with differential, urea, hemoglobin) and curbing premature orders placed before the minimum re-testing interval; and (III)a centrally placed feedback dashboard. The primary outcome was the number of biochemical tests, adjusted for hours of hospitalization and caseload. Secondary outcomes were the proportion of results outside reference intervals and re‑testing intervals for common biochemical tests. Safety balancing measures were length of stay, discharges after noon, and 30-day readmissions. The pre-intervention period ran from February 27th, 2022, to February 26th, 2023, post-intervention period from March 5th, 2023, to February 2nd, 2025. After biochemical profile refinement in June 2023, median number of biochemical tests decreased 54% (hours of hospitalization adjusted) and 48% (caseload adjusted). The proportion of test results outside reference ranges increased 21%. Re-testing intervals lengthened for hemoglobin and troponin-I. Balancing measures showed no adverse signals, and effects persisted into February 2025. A pragmatic, simple bundle halved routine biochemical tests and increased diagnostic yield without measurable harm.

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