优化急诊护理流程对脑卒中患者抢救效果及满意度的影响

目的 观察并分析优化急诊护理流程对脑卒中患者抢救效果及满意度的影响.方法 随机选取2011年10月~2014年5月该院收诊的脑卒中患者82例,依照入院抢救时间顺序将其分为观察组42例和对照组40例.对照组患者给予常规急诊护理流程配合抢救,观察组患者给予根据本院实际情况(包括医疗水平与我院所在地的实际生活水平等)所制定的优化后的急诊护理流程进行抢救.观察并比较两组患者接诊到确诊的时间、确诊到专科诊治的时间,及患者接受治疗后的病死率、致残率及并发症的发生率,调查并分析患者对优化的急诊护理流程治疗脑卒中患者的满意度.结果 经诊断,观察组与对照组的脑卒中类型比较,差异无统计学意义(P>0.05);观察组患者的治疗情况,包括接诊-确诊时间、确诊-接受专科治疗时间及住院费用等均明显优于对照组,差异均有统计学意义(均P<0.05);且观察组患者的致死率与致残率明显低于对照组,差异均有统计学意义(均P<0.05);除此之外,观察组患者的抢救满意度明显优于对照组患者,差异有明显统计学意义(P<0.05).结论 优化急诊护理流程可有效缩短接诊及诊断时间,降低患者的病死率与致残率,减少患者相关并发症的发生率,提高脑卒中患者的抢救效果及满意度等,值得推广应用.     

设立“天使前哨战”推行急诊优质护理服务

目的:探讨推行急诊优质护理服务的措施和效果。方法 :在急诊分诊区设立"天使前哨战",更新服务理念,强化服务意识,让分诊护士走出分诊台,零距离检诊、评估患者。结果 :设立"天使前哨战"前后,接诊护士的服务态度、与患者的语言沟通能力、患者综合满意度方面的差异有统计学意义(P<0.05)。结论 :设立"天使前哨战"增强了急诊科护士主动服务的意识,实现了零距离分诊,快速分流、分诊等候患者,使真正需要急救的患者得到及时的救治,降低医疗护理风险,不断提高患者满意度。     

急诊患者满意度相关因素的调查分析

目的探讨急诊护理工作量和人力资源配置对患者满意度的影响。方法采用单因素及多因素回归法对我院急诊科2001年1月1日至2003年12月30日护理工作量、人力资源配置和患者满意度进行回顾性研究。结果(1)4～12月呈显著负相关(P<0.05),急诊工作时间在12～36个月和>36个月的护理人员和护工人员数量与患者满意度有显著正相关P<0.05或P<0.01);(2)护工人员的人数与患者满意度呈正相关(P<0.01);(3)急诊护理工作量与满意度呈显著负相关(P<0.01)。结论合理的人力资源配置和适宜的护理工作量有利于提高急诊护理满意度。     

标准模式化护理在急诊患者转运过程中的应用

目的:探讨标准模式化护理在急诊患者转运过程中的应用效果。方法:将急诊科收治入院的2 482例患者随机分为观察组与对照组各1 241例,观察组采用标准模式化护理,对照组采用常规入院护理;比较两组患者入院过程中的缺陷情况、交接时间、科室之间及护患之间的纠纷及满意度。结果:观察组交接时间、纠纷及缺陷发生率均少于对照组(P<0.05),患者及护士满意度高于对照组(P<0.01)。结论:采用标准模式化护理对急诊患者实施入院交接,规范了交接流程,明确了交接内容,能提高急诊护士工作质量和工作效率,降低工作缺陷率,加强护士责任心,有利于护患以及科室之间协调,减少纠纷,从而为患者提供了安全优质、高效的护理,值得推广应用。     

急诊护理路径在降低急性脑卒中患者病死率及致残率中的临床应用价值研究

目的分析优化急诊护理路径在降低急性脑卒中患者病死率及致残率中的临床应用价值。方法选取2018年7月至2021年7月在我院就诊的100例急性脑卒中患者,随机分为观察组和对照组各50例。观察组行常规护理,对照组行优化急诊护理路径,比较两组接诊到确诊时间、确诊到专科治疗时间、护理满意度及病死率、致残率。结果观察组接诊到确诊时间、确诊到专科治疗时间显著短于对照组(P<0.05);观察组护理满意度显著高于对照组(P<0.05);观察组病死率、致残率显著低于对照组(P<0.05)。结论优化急诊护理路径可明显缩短急性脑卒中患者的转运时间及就诊时间,为患者的治疗争取了时间,临床效果显著,对于改善患者病情及护理满意度,具有应用价值。     

PDCA循环管理在患者急诊留观安全护理过程中的应用效果

目的探究PDCA循环管理在急诊留观安全护理过程中的应用效果。方法选择2015年6月至2018年6月于我院急诊留观的3300例患者为研究对象,按照不同的安全护理模式分成对照组与观察组,对照组采用常规管理,观察组在对照组基础上采用PDCA循环管理。比较两组人均耗材费用、不良事件发生率、满意度。结果观察组人均耗材费用明显少于对照组(P<0.05),不良事件发生率低于对照组(P<0.05),患者满意度高于对照组(P<0.05)。结论PDCA循环管理模式应用于急诊留观患者,可提升护理安全性,提高患者满意度。     

建立标准化转运流程在急诊患者安全管理中的应用

目的:探讨建立标准化转运流程在急诊转运患者中的应用效果。方法:将2010年3～8月收治的75例急诊转运患者设为对照组,将2010年9月～2011年2月收治的86例急诊转运患者设为实验组。对照组采用传统转运方法,实验组采用标准化转运流程,两组分别运用转运患者不良事件调查表、急诊转运患者交接情况调查表、急诊转运患者满意度调查表来进行评定。结果:实验组不良事件发生例数低于对照组(P<0.01),实验组患者满意度高于对照组(P<0.05),实验组医务人员满意度高于对照组(P<0.05)。结论:标准化转运流程可保障患者安全,降低不良事件发生,提高患者和合作科室满意度。     

探讨改良早期预警评分对不同情形急诊患者的应用效果

目的:分析救护车接诊时对急诊患者进行改良早期预警评分(MEWS),探讨MEWS在患者风险管理中的应用价值。方法:选择2016年2月至2017年2月所有急诊就诊患者基本信息共120例,分为救护车接诊时评分和到急诊室评分。比较两组不同流向患者评分的差异,并调查医生、护士对实施MEWS管理模式的满意度。结果:120例患者评分后分别转入急诊内科、急诊外科。接诊时MEWS评分与到急诊室评分差异无显著性(P0.05),可见MEWS评分可用于多种状况。救护车接诊时就进行MEWS评分可大大降低分类所用时间,差异具有显著性(P0.01)。两组分流的准确性相比,差异无显著性(P0.05);此外,医生和护士的满意度调查发现接诊时就进行MEWS评分得到了更多医护人员的支持(P0.01)。结论:救护车接诊时进行MEWS评分,与急诊室无差异,不但可以大大缩短分类时间,而且得到医护人员的肯定,值得临床推广。     

PDCA管理模式在急危重症患者急救流程中的应用

目的 探讨PDCA管理模式在急危重症患者急救流程中的应用效果.方法 由某三级甲等医院急诊科的12名主管护师组成PDCA管理小组,以2014年7~12月急诊接诊患者的护理程序为调查对象.此时间段内的患者按照常规的就诊流程就诊,PDCA管理小组成员对此时间段内相关的急诊、急救护理质量进行现状调查,找出目前存在的护理质量问题,针对问题进一步分析原因、制定计划、改进措施,实施方案、定时监控检查,持续质量改进.对经PDCA管理后的2015年4~9月急诊接诊患者的护理程序再次进行统计调查,比较改善前后对应的指标,包括急危重症患者的抢救时间和患者对护理的满意度.结果 将改善前与改善后急危重症患者的抢救时间进行比较分析,差异有统计学意义(P<0.05);将患者的满意度进行比较分析,差异有统计学意义(P<0.05);将2015年10~12月的相关指标与改善后进行比较分析,差异有统计学意义(P<0.05).说明巩固调查阶段的急诊急救质量优于改善后的急救质量,且在持续质量改进中.结论 PDCA管理模式的实施,可显著缩短急危重症患者的抢救时间,提高患者的护理满意度.PDCA管理模式可被用作护理管理层简单可靠的质控管理工具.     

整体理念护理程序对提高接诊重症患者院内转运效率和安全性的影响

目的:探讨整体理念护理程序对提高接诊重症患者院内转运效率和安全性的影响。方法:选择2015年1~12月120例急诊接诊重症患者为对照组,采用常规护理模式。选择2016年1~9月120例急诊接诊重症患者作为观察组,实施整体理念护理程序,比较两组患者转运时间、转运过程中意外事件和不良事件发生率。结果:观察组患者转运用时短于对照组(P<0.05),意外事件和不良事件发生率低于对照组(P<0.05)。结论:整体理念护理程序可提高重症患者院内转运效率和安全性。     

4级分级标准在急诊分诊工作中的应用研究

目的 探讨《医院急诊科规范化流程》(4级分级标准)在急诊分诊中的应用效果。方法 选取2016年6月1日-2016年7月1日于本院急诊科就诊的1 252例患者按4级分级标准进行分诊评估,以改良早期预警评分(modified early warning score,MEWS)分级标准作为对照,比较2种标准的分诊结果、分诊时间。结果 4级分级标准与MEWS标准的分诊时间分别为(3.1±0.5)min、(3.9±0.7)min,2者比较差异有统计学意义(t=6.341,P=0.018)。2种标准分诊结果比较,差异无统计学意义(Z=-0.220,P=0.826)。结论 《医院急诊科规范化流程》推荐的4级分级标准安全可靠,且分诊时间短于MEWS标准,适合在我国急诊就诊量快速增长的急诊部门推广应用。     

校正改良式早期预警系统在心胸专科急诊分诊中的应用

目的将改良式早期预警(modified early warning score,MEWS)与胸科专科预检标准相结合,构建适用于心胸专科急诊分诊的校正MEWS系统,探讨其对于心胸专科急诊预检分诊工作的影响。方法便利抽样法选取上海交通大学附属胸科医院2015年9-12月急诊就诊患者8994例为对照组,2016年1-3月急诊就诊患者9138例为观察组。对照组患者按常规的急诊分诊流程处理,观察组患者实施校正MEWS系统的评分结果进行预检及分区分级处置,比较两组患者急诊分诊时间及分诊正确率、高危胸痛患者识别率、应急处理率,医生、护士及患者满意率。结果两组患者的分诊时间、分诊正确率、有效识别高危胸痛患者、应急处理率、患者满意率经比较,观察组患者均优于对照组,差异均有统计学意义(均P0.05)。结论校正MEWS评分系统便于急诊护士快速准确地分诊,同时可有效识别胸痛高危患者,提高心胸专科急诊预检分诊工作的可操作性及准确率,有助于急诊患者在最短时间内得到规范、科学、适当、合理、及时的救治。     

A study of triage of paediatric patients in Australia

Objectives: To describe the triage of children in a sample of mixed and paediatric emergency departments in Australia in 1999 and to measure the inter‐rater reliability of the National Triage Scale when used by triage nurses for the triage of paediatric patients. Methods: A questionnaire was sent to 11 hospitals, including one paediatric and one mixed emergency department, in each state studied. Triage nurses were asked to assess 25 paediatric patient profiles and to assign appropriate triage categories to each profile. The number of responses within the modal triage category (concurrence), the percentage of responses with a concurrence of at least 50% and the number of responses within one triage category of the modal response (spread) of responses were measured. Triage data for 1999 from the same emergency departments were collected and numbers of children seen and admitted in each triage category were described. The patterns of distribution of triage categories for specific paediatric diagnoses (triage ‘footprints’) were also described. Data from mixed emergency departments were grouped and compared with data from paediatric emergency departments and any differences were described. Results: Seventy‐eight nurses in 10 hospitals responded to the questionnaire. Sixty‐three per cent of all responses had a concurrence of greater than 50%. Ninety‐four per cent of patient profiles were triaged to within one triage category of their modal response. Nurses in paediatric emergency departments (concurrence greater than 50% for 79% of responses) were significantly more consistent in their use of the National Triage Scale compared with nurses in mixed emergency departments (concurrence greater than 50% for 50% of responses). Paediatric emergency department triage nurses were more likely to use the full range of the National Triage Scale and were fourfold as likely to allocate triage categories 4 and 5 to patient profiles. Paediatric hospitals allocated patients to triage categories 4 and 5 for an average of 71% of presentations compared with 47% for mixed emergency departments. Specific diagnoses had characteristic distributions of triage categories, with similar differences seen when comparisons were made between mixed and paediatric emergency departments. Conclusion: Use of the National Triage Scale for the triage of paediatric patients by triage staff is not consistent and there are significant differences between the triage practices of paediatric and mixed emergency departments.     

Reliability and Validity of Scores on the Emergency Severity Index Version 3

OBJECTIVES: No widely used triage instrument accurately assesses patient acuity. The Emergency Severity Index (ESI) promises to facilitate reliable acuity assessment and possibly predict patient disposition. However, reliability and validity of ESI scores have not been established in emergency departments (EDs) outside the original research sites, and version 3 (v.3) of the ESI has not been evaluated. The study hypothesis was that scores on the ESI v.3 show good interrater reliability and predict hospital admission, admission site, and death. METHODS: The authors conducted an ED-based cross-sectional retrospective study of 403 systematically selected ED records of patients who presented to an academic medical center. Twenty-seven variables were abstracted, including triage level assigned, admission status, site, and death. Using a standard process, the researchers determined the true triage level. Weighted kappa and Pearson correlation were used to calculate interrater reliability between true triage level and triage score assigned by the registered nurse (RN). The relationships between the true ESI level and admission, admission site, and death were assessed. RESULTS: Interrater reliability between RN ESI level and the true ESI level was kappa = 0.89; Pearson r = 0.83 (p < 0.001). Hospital admission by ESI level was as follows: 1 (80%), 2 (73%), 3 (51%), 4 (6%), and 5 (5%). A higher percentage of ESI level-1 and level-2 patients (40%, 12%) were admitted to the intensive care unit than ESI levels 3-5 (2%, 0%, 0%). Admission to telemetry for ESI levels 1-5 was 20%, 19%, 7%, 1%, and 0%, respectively. Three of four patients who died were ESI level 1 or 2. CONCLUSIONS: Scores on the ESI assigned by nurses have excellent interrater reliability and predict hospital admission and location of admission.     

急诊分诊管理程序的软件开发与应用研究

目的 为了改进急诊分诊管理的方法,提高管理功效.方法 2001年3月至2003年8月,由计算机管理中心和急诊科人员组成课题小组,开发研制"急诊分诊护理管理程序软件",通过该软件的预检信息录入、查询系统、检索系统、信息汇总系统、数据图表系统、趋势图表分析、结果统计等功能,实现了急诊分诊管理的数字化和智能化.结果 经2年实践,该软件处理20余万急诊患者信息,急诊预检分诊正确率从92.1%上升到97.8%,P＜0.05;手工记录与计算机录入,两者时间比较P＜0.01,差异均有统计学意义.结论 该软件的应用,促进了急诊分诊的科学化和系统化管理,提高了分诊工作效率.     

Triage in emergency departments: national survey

Aim. This paper reports a study the aim of which was to describe how triage‐related work was organized and performed in Swedish emergency departments. Background. Hospitals in many developed countries use some kind of system to prioritize the patients attending emergency departments. Triage is a commonly used term to refer to the process of sorting and prioritizing patients for care. How the triage procedure is organized and which personnel perform this type of work vary considerably throughout the world. In Sweden, few studies have explored this important issue. Method. A national survey was conducted using telephone interviews, with nurse managers at each of the emergency departments. The sample represented 87% of emergency departments in Sweden. Results. The findings clearly illustrate the organization of emergency department triage, focusing on personnel who perform triage, as well as the facilities, resources and procedures available for triage. However, the results indicate that work associated with such triage in Sweden is not organized in any consistent matter. In 81% of the emergency departments a clerk, Licensed Practical Nurse or Registered Nurse were assigned to assess patients not arriving by ambulance. There was also diversity in other areas, including requirements for staff to have particular qualifications and clinical experience for being allocated to triage work, as well as facilities for triage personnel assessing and prioritizing patients. The use of triage scales and acuity ratings also lacked uniformity and disparities were observed in both the design and use of triage scales. A little less than half (46%) of the emergency departments did not use any kind of triage scale to document patient acuity ratings. Conclusion. In contrast to several other countries, this study shows that Swedish emergency departments do not adhere well to established standards and guidelines about triage in emergency care. Research on emergency department triage, especially in the areas of personnel performing triage, triage scales and standards and guidelines are recommended. Relevance to clinical practice. The diversity among several aspects of nursing triage (e.g. use of less qualified personnel performing triage, the use of different triage scales) presented in the study points to a safety risk for the patients. It also shows the need of further education for the personnel in clinical practice as well as further research on triage in order to gain national consensus about this nursing task.     

急诊分诊护士准入制度对比及借鉴

急诊分诊护士准人制度是护理专业化发展的趋势之一,目前国内还没有针对急诊分诊护士资质准入制度的相关规定。对急诊分诊护士提出统一的要求,进行统一的岗前培训与考核,取得资质证书后方能上岗,这样可以大大提高急诊预检分诊的质量,降低医疗纠纷的发生。本文介绍了目前国内外急诊分诊护士岗位资质要求、对于分诊护士的培训方式、培训内容及职责范围的差异。     

Do the national performance tables really indicate the performance of accident and emergency departments?

OBJECTIVE--To determine the current practice of nurse triage in accident and emergency departments in England, and to examine the relation between triage systems and performance in the Department of Health comparative performance guide. DESIGN--A postal questionnaire was sent to all consultants in accident and emergency medicine in England. RESULTS--151 responses were analysed, representing 72% of the departments seeing at least 15,000 new patients annually. Triage systems vary widely throughout departments, ranging between advanced triage, partial triage, and "eyeballing". There is no standardisation of the process or duration of triage. There appears to be no standard method of measuring the time to immediate assessment. There is no correlation between the quality of initial assessment and performance in the tables. CONCLUSION--The national performance figures do not correlate with the quality of the initial assessment; comparisons based on these figures are therefore misleading. More effective performance indicators are available, which would provide a truer indication of the quality of accident and emergency services.     

Validity of the Japan Acuity and Triage Scale in elderly patients: A cohort study

BackgroundIn developed nations, the age of patients in emergency departments (ED) continues to increase. Many emergency triage systems, such as the Canadian Triage and Acuity Scale (CTAS), triage patients as a homogenous group, regardless of age. However, older adults have multiple comorbidities and a higher risk of undertriage. The Japan Acuity and Triage Scale (JTAS) was developed based on the CTAS and has been validated for overall adults. We assessed the validity of the JTAS for use in elderly ED patients.MethodsThis was a secondary analysis of a cohort study that previously validated the JTAS in self-presenting adults of all ages in the ED of a Japanese tertiary-care hospital. We included non-transferred patients who were ≥65 years old and triaged between June 2013 and May 2014. Our primary outcome measures were overall admission and ED length of stay. Our secondary outcomes included admission to the intensive care units (ICUs) and in-hospital mortality. We examined the association between the triage level and patient outcomes with multivariable logistic regression analysis (overall and ICU admission and in-hospital mortality) and the Kruskal-Wallis rank-sum test (ED length of stay).ResultsWe included a total of 11,087 elderly patients in our study. Higher odds ratios for overall and ICU admission and in-hospital mortality corresponded to higher acuity levels. ED length of stay was significantly longer in patients with a higher JTAS level (p < 0.001). Twenty-nine percent of admissions who were triaged as lower acuity levels were related to non-acute diseases including malignancy-related events.ConclusionOur study suggests an association between the JTAS triage level and clinical outcomes in self-presenting elderly patients, thereby demonstrating the validity of the JTAS in these patients. However, admission due to chronic diseases including malignancy was common in patients who were rated as low acuity level.     

改良早期预警评分在老年急诊中的应用

目的：探讨改良早期预警评分（MEWS）在老年急诊中的应用价值。方法：急诊科留观和抢救室的老年患者216例进行MEWS评分并追踪预后至就诊后四周，对既往急诊收住ICU的老年患者61例进行MEWS评分并行回顾性分析。结果：MEWS评分越高，死亡构成比明显增加。死亡组MEWS评分显著高于存活组（P〈0．01）。未收住ICU的患者的MEWS评分显著低于收住ICU患者评分（P〈0．05）。6h内发生猝死组MEWS评分与6h后死亡组MEWS评分无显著性差异（P〉0.05）。结论：MEWS评分用于老年急诊患者可以判断疾病严重程度，具有识别“潜在危重病”的作用，且简便、实用，便于在急诊中推广。