RESUMO
Though ultrasonography is increasingly used throughout the spectrum of hemodialysis access, its role in outpatient dialysis units in the United States has been limited so far. This may, in part, be due to limited ultrasound exposure, knowledge and training of dialysis staff. We implemented a quality improvement initiative in our dialysis units to expand the use of ultrasound by our frontline dialysis staff to prospectively evaluate newly placed AVF and guide cannulation. This manuscript describes our experience and the impact of our protocol on infiltration rates in our outpatient HD units.
Assuntos
Derivação Arteriovenosa Cirúrgica , Falência Renal Crônica , Humanos , Estados Unidos , Melhoria de Qualidade , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Derivação Arteriovenosa Cirúrgica/métodos , Cateterismo/métodos , Diálise Renal/métodos , Ultrassonografia , Ultrassonografia de IntervençãoRESUMO
Background. The electronic health record (EHR) has been promoted as a tool to improve quality of patient care, reduce costs, and improve efficiency. There is little data to confirm that the use of EHR has reduced duplicate testing. We sought to evaluate the rate of performance of repeat transthoracic echocardiograms before and after the adoption of EHR. Methods. We retrospectively examined the rates of repeat echocardiograms performed before and after the implementation of an EHR system. Results. The baseline rate of repeat testing before EHR was 4.6% at six months and 7.6% at twelve months. In the first year following implementation of EHR, 6.6% of patients underwent a repeat study within 6 months, and 12.9% within twelve months. In the most recent year of EHR usage, 5.7% of patients underwent repeat echocardiography at six months and 11.9% within twelve months. All rates of duplicate testing were significantly higher than their respective pre-EHR rates (p < 0.01 for all). Conclusion. Our study failed to demonstrate a reduction in the rate of duplicate echocardiography testing after the implementation of an EHR system. We feel that this data, combined with other recent analyses, should promote a more rigorous assessment of the initial claims of the benefits associated with EHR implementation.
