Background Abscesses are a common reason for ED visits. While many are drained in the ED, some require drainage in the operating room (OR). We observed that a higher percentage of patients at our institution in Columbus, Ohio, were admitted to the hospital with abscesses for incision and drainage (I&D) in the OR than other institutions, including paediatric institutions. Our aim was to decrease hospitalisations for abscess management. Methods A multidisciplinary team convened to decrease hospitalisation for patients with abscesses and completed multiple ‘Plan-Do-Study-Act’ cycles, including increasing I&Ds performed in the ED. Other interventions included implementation of a clinical pathway, training of procedure technicians (PT), updating the electronic medical record (EMR), credentialing advanced practice nurses in sedation and individual follow-up with providers for admitted patients. Data were analysed using statistical process control charts. Gross average charges were assessed. Results Admissions for I&D decreased from 26.3% to 13.7%. Abscess drainage in the ED improved from 79.3% to 96.5%. Mean length of stay decreased from 19.5 to 11.5 hours for all patients. Patients sedated increased from 3.3% to 18.2%. The number of repeat I&Ds within 30 days decreased from 4.3% to 1.7%. Conclusion We decreased hospitalisations for abscess I&D by using quality improvement methodology. The most influential intervention was an initiative to increase I&Ds performed in the ED. Additional interventions included expanded training of PTs, implementation of a clinical pathway, updating the EMR, improving interdepartmental communication and increasing sedation providers.

中文翻译：

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质量改进方法可以减少脓肿治疗的住院率


背景 脓肿是急诊就诊的常见原因。虽然许多在急诊室引流，但有些需要在手术室 (OR) 引流。我们观察到，与其他机构（包括儿科机构）相比，我们俄亥俄州哥伦布市机构中因脓肿入院进行手术室切开引流 (I&D) 的患者比例更高。我们的目标是减少因脓肿治疗而住院的情况。方法 一个多学科团队聚集在一起，减少脓肿患者的住院治疗，并完成了多个“计划-实施-研究-行动”周期，包括增加在急诊室进行的 I&D。其他干预措施包括实施临床路径、培训手术技术人员 (PT)、更新电子病历 (EMR)、对镇静高级执业护士进行认证以及对入院患者进行个人随访。使用统计过程控制图分析数据。评估了平均总费用。结果 I&D 录取人数从 26.3% 下降至 13.7%。急诊室脓肿引流率从 79.3% 改善至 96.5%。所有患者的平均住院时间从 19.5 小时减少到 11.5 小时。服用镇静剂的患者从 3.3% 增加到 18.2%。 30 天内重复 I&D 的数量从 4.3% 下降到 1.7%。结论 我们通过使用质量改进方法减少了因脓肿 I&D 住院的情况。最有影响力的干预措施是增加急诊室进行的 I&D 的举措。其他干预措施包括扩大 PT 培训、实施临床路径、更新 EMR、改善部门间沟通和增加镇静提供者。