背景无症状性菌尿(ASB)给医疗专业人员带来了严重的诊断困境。当前的医院筛查方案根据床旁尿液分析的结果确定尿路感染(UTI)阳性诊断的可能性。ASB,定义为在没有症状的情况下尿液培养阳性,会导致不必要的取消,戏剧时间利用率低,延迟患者护理。WepresentatwocycleauditproposedanewpathtoaddressingASBinpatientswaitingelective骨科手术,旨在优化手术产量。我们的目标是与已发表的文献相比,在无症状细菌方面确定部门实践中需要改进的地方。我们提出了一种新的协议,旨在改善我们当前的做法,以最大程度地减少患者取消并优化手术室利用率。方法在提供三级骨科服务的大型地区综合医院中,共有78例取消了选择性骨科手术的患者,在2018年3月至2019年4月和2019年5月至2020年3月的两个研究期间,我们通过电子医院记录和手术室管理系统进行了鉴定.人口统计,程序详细信息,以及取消的原因,包括尿液分析结果和UTI症状的存在。我们的途径是在第一个研究阶段后引入的,随后,重新审核,以评估对新协议的遵守情况及其对取消的影响。结果我们确定了78例患者,男性:女性比例为50:50,平均年龄为63岁(范围=9-90)。在第一批的33名患者中,7例(21.2%)因尿检风险而取消,基于尿检阳性。在这七个取消中,1例(14.3%)患者报告了UTI症状.第二个队列包括45名患者,根据症状问卷结果,其中2人(4.4%)因UTI风险被取消.发现这两名有症状的患者以及另外两名无症状的患者(总计8.8%)的尿液分析呈阳性;但是,两名无症状患者因无关原因取消了手术。结论研究表明,以前所有等待择期骨科手术的患者都取消了手术,85.7%因ASB而被取消。在引入了一种关注症状而不是尿液分析的新方案后,我们估计取消的择期骨科手术数量减少了71.4%,从而大大提高了戏剧时间的利用率。
Background Asymptomatic bacteriuria (ASB) poses a significant diagnostic dilemma for medical professionals. Current hospital screening protocol determines the likelihood of a positive diagnosis of a urinary tract infection (UTI) based on the results of a bedside urinalysis. ASB, defined as a positive urine culture in the absence of symptoms, can contribute to unnecessary cancellations, poor utilisation of theatre time, and delayed patient care. We present a two-cycle audit proposing a new pathway to addressing ASB in patients awaiting elective orthopaedic surgery, aiming to optimise surgical yield. Our objectives are to identify areas for improvement in our departmental practices with respect to asymptomatic bacteria compared to the published literature. We propose a new protocol targeted to improve our current practices to minimise patient cancellations and optimise theatre utilisation. Methodology A total of 78 patients who had an elective orthopaedic procedure cancelled at a large district general hospital offering tertiary orthopaedic services, between two study periods spanning March 2018 to April 2019 and May 2019 to March 2020, were identified from electronic hospital records and theatre management systems. Demographics, procedure details, and reasons for cancellations, including the result of urinalysis and the presence of UTI symptoms were assessed. Our pathway was introduced after the first study period and, subsequently, re-audited to assess adherence to the new protocol and its effect on cancellations. Results We identified 78 patients, with a 50:50 male:female split and an average age of 63 (range = 9-90). Of the 33 patients in the first cohort, seven (21.2%) were cancelled due to UTI risk based on positive urinalysis. Of these seven cancellations, one (14.3%) patient reported symptoms of a UTI. The second cohort comprised 45 patients, two (4.4%) of whom were cancelled due to UTI risk based on symptom questionnaire results. These two symptomatic patients along with another two asymptomatic patients (8.8% in total) were found to have positive urinalyses; however, the two asymptomatic patients had their operations cancelled for unrelated reasons. Conclusions The study has shown that previously of all patients awaiting elective orthopaedic operations who had their procedures cancelled, 85.7% were cancelled due to ASB. After the introduction of a new protocol focussing on symptoms rather than urinalysis, we estimate that the number of cancelled elective orthopaedic operations has reduced by 71.4%, thereby greatly improving the utilisation of theatre time.