diagnosis and empiric treatment of neutropenic fever in the ...课件

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1、SystemsBasedPracticeandPracticeBasedLearning. Howtoteach? Howtoevaluate?DeborahJ.DeWaayM.D.Hospitalist/ClerkshipDirector,GeneralInternalMedicineMay28th,2010QualityImprovementProjects“Anapproachtothestudyandimprovementoftheprocessesofprovidinghealthca

2、reservicestomeetneedsofclients.”http://www.qaproject.org/methods/resglossary.htmlQualityImprovementProjectsTheProjectsarestartedJulyofthesecondyearofresidency.Allresidentsparticipateinaproject.Theybreakupintogroupsof2-4andaskaquestion.Thequestionshou

3、ldbeabouttheevaluationofaguidelineoraknownbestofpractice.Inaddition,eachgroupwillpickafacultymentor.DiagnosisandEmpiricTreatmentofNeutropenicFeverintheEmergencyRoomMUSCDepartmentofMedicineQualityImprovementProjectJune18,2009FacultyMentors:DeborahDeWa

4、ayMD;KitSimpson,DrPHJonathanAbbasMDErinAlexanderMDLaraLambertMDNeutropenicFeverNeutropenicfeverisamedicalemergencyrequiringinitialinterventionintheemergencyroom.Beforeempiricantibiotictherapy,infectionaccountedfor75%ofallmortalityamongpatientsreceivi

5、ngchemotherapyEarlystudiesshoweda70%increaseinmortalitywithadelayinadministrationofempiricantibioticsonceneutropenicfeverwasidentifiedTheInfectiousDiseaseSocietyofAmerica(IDSA)hasestablishedguidelinesforthetreatmentofneutropenicfeverofunknownoriginin

6、cancerpatients(lastupdated2002)GuidelinesforFebrileNeutropeniaDefinitions:Fever=atemperatureof≥to101°FNeutropenia=absoluteneutrophilcountof<500cells/mm3ProjectQuestionandHypothesesInpatientswhomeetcriteriaforinhospitalIVantibioticsforfebrileneutropen

7、ia,isthetimefromlabnotificationofneutropeniatotreatmentintheemergencydepartmentoptimal?Hypothesis1:Timefromdiagnosisofneutropenicfevertoadministrationofantibioticsis<60minutesfor>95%ofpatientsHypothesis2:Standardtreatmentwithmeropenemisadministeredin

8、>95%ofpatientsreceivingantibioticsQualityImprovementProjectsTheDepartmentofMedicinehashiredamethodologist/statisticianto:Helpdesigntheprojects.Pullthedatafromthedatabases.Calculatethestatisticsonthedata.StudyDesignAnalysis:DescriptiveDataidentifying-