事件记录
主持人: Now a shorter hospital stay 和 a faster recovery for children that need an appendectomy. 大发娱乐将在接下来的《大发娱乐》节目中对此进行详细介绍.
Medical news 和 research from the University of Utah physicians 和 specialists you can use for a happier 和 healthier life. 您正在收听的是范围.
Dr. 大卫Skarda, assistant professor in the department of surgery at the University of Utah. 你知道, it surprised me when I found out that appendectomy patients had to stay in the hospital for a certain number of days regardless of how they were actually doing. Can you talk about that a little bit 和 why you decided to examine that as a way to maybe help recovery 和 save some money?
Dr. Skarda: 传统上,在 小儿外科手术 和, 特别是, 年轻的阑尾炎患者, 大发娱乐很担心可能会出现并发症, 特别是, 腹腔内感染. 因为高度的关注, we essentially created protocols for treating these patients after their appendectomy, 其中静脉注射抗生素的持续时间相对较长，持续时间为7, 10, 14, 有时住院21天, 整个期间都住在医院. 这确实降低了感染率, 大发娱乐认为, but we just treated patients for a very long time with in-patient IV antibiotics.
主持人: 所以在某种程度上，这是一个解决问题的办法.
Dr. Skarda: 这是正确的.
主持人: 然后你开始重新审视它. What caused you to think, "Well, maybe we can actually shorten these stays?"
Dr. Skarda: We noticed here at Primary Children's that a fairly large percentage of these patients were ready to go home two or three days after their appendectomy. 因为大发娱乐已经制定了协议, 他们被要求在医院里待到那个时候.
主持人: 是的. So they were feeling fine, 和 everything looked good as far as you were concerned. 但他们不得不留下来.
Dr. Skarda: 他们必须留下，因为他们需要静脉注射抗生素.
主持人: 是的. 因为这是协议规定的.
Dr. Skarda: And that was consistent, I think, with most children's hospitals across the United States.
患者体验驱动方案测试
主持人: 好吧. 然后是什么让你想到，“也许大发娱乐可以缩短这个”? I mean, how do you go through that process of suggesting that this is a better way to do it, maybe?
Dr. Skarda: 大发娱乐作为一群外科医生讨论这个问题已经有一段时间了. 仔细看这个问题, we realized that there was a very high likelihood that these patients who are ready to go home probably no longer needed antibiotics. And I think that the critical issue here was that not all patients with appendicitis necessarily respond the same way, 可能有些人不需要像其他人那样长时间使用抗生素. 如果大发娱乐能认出他们是谁, 停止使用抗生素, 把他们带出医院, 他们可能会做得更好.
主持人: 是的. 事实上，数据表明.
Dr. Skarda: 是的. 一旦大发娱乐开始 新的协议, 哪个是基于临床反应的, 意思是从手术的那一刻起, we monitor patients every two hours at the bedside to see if they're drinking enough, 吃足够的, 他们的痛苦得到了很好的控制, 如果他们24小时内不发烧, 他们准备回家了. 一旦他们符合这些标准，大发娱乐就会把他们送回家. 化验结果出来的时候大发娱乐会检查的, 基本上, 看看他们是否需要在家里口服抗生素. 有些是这样的. 有些则不然. Then we follow them back in clinic in one week 和 make sure that they're doing well.
主持人: 而且住院时间缩短了多少?
Dr. Skarda: 这个方案使大发娱乐的住院时间平均减少了两天. 从7天到5天, 这减少了大约5美元的护理费用,000 per patient with appendicitis 和 improved their outcome in terms of abscess rate from about nine percent to about five percent.
主持人: 太棒了. 所以它就绕了一圈. 更短的住院时间，更少的钱，更好的结果.
Dr. Skarda: 这是正确的.
主持人: 好吧. 这只是所有的术后程序?
Dr. Skarda: 这是正确的.
规范阑尾炎治疗
主持人: 但这个故事还有更多? 你说的是"大发娱乐能不能再多做点?"
Dr. Skarda: 是的. 完全. So although we accomplished a lot with the post-operative component of this, we realized that there are other areas where we could potentially improve. In most children's hospitals, there are many different surgeons performing 阑尾切除手术, 和 each of them perform their appendectomy in a slightly different way depending upon where they were trained, 谁训练他们的？, 什么对他们来说是舒服的.
Oftentimes, though, the instruments used to perform the appendectomy are relatively expensive. Given this variable nature of a lot of ways to make a taco or do an appendectomy, what we figured out is that there's probably a good way that we can perform 阑尾切除手术. We can essentially st和ardize the procedure so that everyone's doing it the same way. I then spent a lot of time 和 identified a specific set of devices 和 a specific way to do the appendectomy that was cost-effective 和 efficient. 然后我让我所有的合作伙伴都同意在小学做这件事.
主持人: 这很难做到吗?
Dr. Skarda: 你知道吗，其实不是. 我想他们看到数据后, 他们看到了可变性, 他们看到了其中的成本, 他们看到了用同样的方式做这件事的可能性, 他们实际上很快就同意了. 一旦程序本身标准化了, we were able to decrease the cost per appendectomy at Primary Children's from about $800 or $900 in disposable devices that would never be used again to about $150 to $200 of disposable devices 和, 坦率地说, 可重复使用的设备. 大发娱乐实施这个计划已经一年多了, 考虑到大发娱乐大发娱乐每年大约有500例阑尾切除术, 这最终节省了大约200美元的成本,000 to $250,1万美元一年.
主持人: 不是一笔微不足道的钱, especially in today's day 和 age when everybody's talking about healthcare costs 和 insurance premiums.
Dr. Skarda: 正确的. Well, it's really all about value, which incorporates the importance of having good outcomes. We monitor those as we made these changes, 和, again, our outcomes have actually improved. 脓肿越来越少了, 住院时间缩短, 缩短手术时间, 大发娱乐的医生很高兴. 更重要的是，家长和病人都很高兴.
在uu of U Health开辟道路
主持人: 是的. 这是令人兴奋的事情. 这是一种常见的事情吗, that procedures are st和ardized 和 we don't necessarily look at the equipment used as closely as we should throughout medicine, 还是说这只是这个手术的独特之处?
Dr. Skarda: I suspect there's been some drive towards st和ardizing procedures in other countries. However, in the United States, to my knowledge, this is the first successful attempt to do that.
主持人: 嗯，这很令人兴奋. 是不是其他医院发现了，问你是怎么做到的? 这是你在传递的东西吗?
Dr. Skarda: 是的. 这是毫无疑问的. 其他机构对此非常感兴趣. This data will be presented this fall at the AAP Conference in San Diego, 和 we anticipate that as this information 和 this idea is disseminated throughout the United States that there will be a significant degree of adoption. There's a great deal of interest, of course, in value, improving care, 和 decreasing cost. 这当然属于这一类.
主持人: 你下一步打算修复哪里?
Dr. Skarda: We've also st和ardized cholecystectomy, or removal of gall bladders at Primary Children's. 大发娱乐正在考虑进行其他手术.
主持人: 最后的想法?
Dr. Skarda: 我认为在医药领域有巨大的机会, 特别是, at Primary Children's Hospital to st和ardize 和 improve care 和 improve value.