急诊科护士掌握急救知识和技能的现状分析及对策

目的了解急诊科护士对急救知识、技能的获取途径、掌握现状及学习需求 ,探讨影响其业务素质的因素以及对急诊科护士进行继续教育的意义和实施方法。方法采用问卷调查法对上海市 9所医院 2 82名急诊科护士进行调查 ,统计处理用Excel和SAS软件包进行。结果急诊护士的平均知识得分为 71 .95± 1 0 .75 ,但作为急诊中坚力量的年轻护士平均知识得分不尽如意 ,说明急诊科护士整体素质有待于进一步提高 ,原因可能与缺乏系统的岗位培训有关。不同级别医院知识得分差异不显著。结论急诊科护士急救知识技能的总体水平需进一步提高 ,低护龄护士毕业后教育工作应引起高度重视。急诊科护士的继续教育应结合医院实际、针对薄弱环节开展     

综合性三甲医院急诊室抢救患者滞留状况的研究

目的调查某家综合性三甲医院抢救患者在急诊室的滞留状况,为进一步加快急诊抢救患者的分流,提高急诊服务质量提供依据。方法使用急诊预检分诊数据库,回顾性调查分析某综合性三甲医院2010年全年急诊室抢救患者的相关信息,包括不同月份、不同科室、不同去向抢救患者的滞留时间及可能的原因。结果①该院全年7966例抢救患者在急诊室滞留的时间为0.5～2998 h,中位数10 h（四分位数3～23 h）;②不同月份抢救患者的滞留时间比较差异有统计学意义（χ2=22.869,P=0.018）,其中2月份最短,5月份最长;③患者对急诊抢救室床位占用时间最长的4个科室依次为急诊内科、神经外科、神经内科和急诊科,合计达91.8%的总床位占用时间。患者在急诊抢救室滞留时间最长的4位科室依次为急诊内科、神经内科、神经外科和胸外科;④不同去向的抢救患者滞留时间比较差异有统计学意义（χ2=731.471,P〈0.0001）,其中以直接住院和自动出院患者的滞留时间最长;⑤滞留时间24 h以上的抢救患者中,83.4%与相应的专科病房无床有关。结论该家医院急诊室抢救患者的滞留状况比较严重,其中急诊内科、神经内科、神经外科3个科室尤为严重,主要与相应专科的病房床位供应不足有关,医院有必要采取相应的对策。     

The influence of crowding on clinical practice in the emergency department

Background

This study aimed to clarify the association between the crowding and clinical practice in the emergency department (ED).

Can different physicians providing urgent and non-urgent treatment improve patient flow in emergency department?

Background

Emergency Department (ED) overcrowding is a worldwide problem, and it might be caused by prolonged patient stay in the ED. This study tried to analyze if different practice models influence patient flow in the ED.

Scandinavian pre-hospital physician-manned Emergency Medical Services—Same concept across borders?

Background

In Scandinavia, scattered populations and challenging geographical and climatic conditions necessitate highly advanced medical treatment by qualified pre-hospital services. Just like every other part of the health care system, the specialized pre-hospital EMS should aim to optimize its resource use, and critically review as well as continuously assess the quality of its practices. This study aims to provide a comprehensive profile of the pre-hospital, physician-manned EMS in the Scandinavian countries.

Methods

The study was designed as a web-based cross-sectional survey. All specialized pre-hospital, physician-manned services in Scandinavia were invited, and data concerning organization, qualification and medical activity in 2007 were mapped.

Results

Of the 41 invited services, 37 responded, which corresponds to a response rate of 90% (Finland 86%, Sweden 83%, Denmark 92%, Norway 94%). Organization and education are basically identical. All services provide advanced life support and have short response intervals. Services take care of a variety of patient groups, and skills are needed not only in procedures, but also in diagnostics, logistics, intensive care, and mass-casualty management. Consistent and detailed medical documentation was often lacking, however.Differences are mainly related to time variables, patient volume, and service area. The Danish and Swedish services have higher volumes of patient care encounters while the Finnish and Norwegian ones provide a wider variety of medical services.

Conclusions

This survey documented several significant similarities among pre-hospital physician-staffed EMS systems in Scandinavia. Although medical data registration is currently under-developed, Scandinavian physician-manned EMS is a feasible arena for future multi-centre research.     

“三位一体”急救模式下急诊护士岗位培训方法的探讨

目的 探讨“三位一体”急救模式下急诊护士岗位培训方法.方法 对参加工作10年以下的77名急诊护士,根据工作年限分成不同层次,针对性地制定不同的培训内容、考核标准,实行分阶段、分层次岗位培训.培训内容设有应急能力、急诊专科实践、评判性思维、护理科研、临床实践等.结果 通过对77名急诊护士的岗位培训,急救护理整体水平提升,人力资源得到有效利用,急诊医学部应对突发公共卫生事件的整体能力提高.结论 三位一体急救模式下,多元化的急诊护士岗位培训,能促进急诊护理的发展,适应快速发展的急诊医学.     

EMS system in Croatia

This article describes the features of Croatia's emergency medical services. Pre-hospital emergency medical services (EMS) access, regional differences and the main features of the service are described. EMS personnel education and skill levels are also discussed. The author offers a critical analysis of the current status and proposals for the future development of emergency medicine in Croatia based on changes in organisation and education.     

福建省立医院急诊优先系统的设计与评价

目的设计与评价缓解急诊科患者大量滞留现状的急诊优先系统。方法设计并应用急诊优先系统比较急诊科从2009年3月到2010年3月（急诊优先系统应用前）及2010年4月到2011年4月（急诊优先系统应用后）急诊科患者24h内入院的月平均人数、患者入院前平均滞留急诊科时间及急诊科月平均抢救人数。结果通过急诊优先系统的应用,急诊科患者24h内入院的月平均人数增加了20．7％,入院前平均滞留急诊科时间下降了33．2％,急诊科月平均抢救人数增加了14．1％。结论急诊优先系统能解决急诊科大量患者滞留、病房选择择期入院患者而导致急诊患者无法及时收入院,急诊通道不畅通等问题,缓解了急诊患者滞留急诊科所导致的隐患。     

Emergency medicine in Poland

The article describes the feature of Poland's emergency medicine services system. Pre-hospital emergency medical service (EMS) access, regional differences and the main features of the system are described. EMS personal education and skill level are discussed. The authors offer a critical analysis of the current situation and proposal for the future development of emergency medicine in Poland based on changes in law, organization and education.     

探索符合国情的急诊流程设计

急诊医学作为一门新兴学科,其发展方向会因各国国情、经济、急诊医学教育、体制的不同,在急诊医学发展水平和急诊流程上千差万别。急诊流程的设计应以时间为基线,建立完善的急救医疗服务体系,但我国目前急诊流程现状堪忧,急诊医学工作中的＂急难险重＂、工作环境的脏乱差、人员素质的良莠不齐,专业化程度低、性价比低、流程僵化与缺少差异化、人性化服务等使得急诊科成为医疗纠纷的重灾区。为改善目前现状,探索符合中国国情的急诊流程,应：①建立＂多维、立体、全覆盖、无缝隙＂的紧急医疗体系;②确定核心价值观;③确立流程设计的指导思想;④寻求工具和切入点;⑤创建包括院前急救、院内急救和ICU一体化、创伤中心与急诊救命手术室并设、胸痛中心等一站式服务模式,同时建立院内心肺复苏（CPR）机动小组,构建真正的急诊绿色通道,采取多样化与因地制宜的模式,不断进行优化,让全员参与有自我纠错能力、持续改进,通过以上方法设计出完全符合自身发展的急诊流程。     

102例急诊科非创伤性死亡病例分析

目的了解急诊科非创伤性死亡的病因构成和救治状况,为制定预防措施提供依据。方法对我院2009年全年急诊科非创伤性死亡病例进行回顾性分析,对以上患者的性别、年龄、病因、抢救时间、抢救措施等资料进行整理。结果平均死亡年龄为68．1岁,以70—80岁年龄段最多;23．5％的死亡病例小于60岁;非创伤性死亡原因依次为心脏病、脑血管病、呼吸系统疾病、猝死、恶性肿瘤,心脑血管病占58．8％;猝死、急性脑血管病患者在急诊抢救室滞留时间长。结论①心脑血管疾病占急诊非创伤性死亡病例的大部分;②应重视改善急诊危重抢救措施。     

Demand for hospital emergency departments: a conceptual understanding

BACKGROUND:

Emergency departments (EDs) are critical to the management of acute illness and injury, and the provision of health system access. However, EDs have become increasingly congested due to increased demand, increased complexity of care and blocked access to ongoing care (access block). Congestion has clinical and organisational implications. This paper aims to describe the factors that appear to influence demand for ED services, and their interrelationships as the basis for further research into the role of private hospital EDs.

DATA SOURCES:

Multiple databases (PubMed, ProQuest, Academic Search Elite and Science Direct) and relevant journals were searched using terms related to EDs and emergency health needs. Literature pertaining to emergency department utilisation worldwide was identified, and articles selected for further examination on the basis of their relevance and significance to ED demand.

RESULTS:

Factors influencing ED demand can be categorized into those describing the health needs of the patients, those predisposing a patient to seeking help, and those relating to policy factors such as provision of services and insurance status. This paper describes the factors influencing ED presentations, and proposes a novel conceptual map of their interrelationship.

CONCLUSION:

This review has explored the factors contributing to the growing demand for ED care, the influence these factors have on ED demand, and their interrelationships depicted in the conceptual model.KEY WORDS: Emergency department, Demand, Crowding, Risk factors, Emergency services, Emergency medicine, Emergency room     

Rural emergency nurse: A true story

The risk rural emergency nurses who practice in their own community face is that they one day may have to care for someone close to them or a member of their own family. My journey involved several presentations to the Emergency Department by people I loved, sometimes with devastating results, while still being stricken with grief from the sudden loss of my mother. Altogether, I attended eight funerals in ten months.Seeking professional help was a crucial step in the healing process.     

Venous thromboembolism in the emergency department: A survey of current best practice awareness in physicians and nurses in China

BACKGROUND: For emergency department (ED) patients, risk assessment, prophylaxis, early diagnosis and appropriate treatment of venous thromboembolism (VTE) are essential for preventing morbidity and mortality. This study aimes to investigate knowledge amongst emergency medical staff in the management of VTE. METHODS: We designed a questionnaire based on multiple scales. The questionnaire was distributed to the medical and nursing clinical staff in the large urban ED of a medical center in Northern China. Data was described with percentages and the Kruskal-Wallis test was used to compare ranked data between different groups. The statistical analysis was done using the SPSS 22.0 software.RESULTS: In this survey, 180 questionnaires were distributed and 174 valid responses (response rate of 96.67%) were collected and analyzed. In scores of VTE knowledge, no significant differences were found with respect to job (doctor vs. nurse), the number of years working in clinical medicine, education level, and current position, previous hospital experience and nurses’ current work location within the ED. However, in pair wise comparison, we found participants who worked in ED for more than 5 years (n=83) scored significantly higher on the questionnaire than those under 5 years (n=91) (95.75 vs. 79.97, P=0.039). There was a significant difference in some questions based on gender, age, job, and nurse work location, number of working years, education level, and different ED working lifetime. CONCLUSION: Our survey has shown deficiencies among ED medical staff in knowledge and awareness of the management of VTE. We recommend several changes be considered, such as the introduction of an interdisciplinary workshop for medical staff; the introduction of a standardized VTE protocol; a mandatory study module on VTE for new physicians and nurses; the introduction of a mandatory reporting system for adverse events (including VTE).     

Violence toward emergency physicians: A prospective-descriptive study

BACKGROUND: The highest rate of workplace violence occurs in the health sector, although most cases remain unreported. Emergency services face the majority of these incidents for many reasons, such as the patient profile, long waiting time, and overcrowding. We aimed to determine the characteristics and causes of violence toward emergency physicians.     

Diffusion and practice of ultrasound in emergency medicine departments in Italy

Introduction

This paper reports data from a cognitive survey on the diffusion, practice and organization of ultrasound (US) in emergency medicine departments (EMDs) in Italy. The study was carried out by the Emergency Medicine Section of the Italian Society for Ultrasound in Medicine and Biology (SIUMB) in collaboration with the Italian Society for Emergency Medicine and Urgent Care (SIMEU).

Methods

We created a questionnaire with 10 items, relating to 4 thematic areas. The questionnaires were administered from September 2007 to February 2008, by email, telephone or regular mail. In August 2008 the data were subjected to nonparametric statistical analysis (Spearman''s Rho and Pearson''s chi-square – software SPSS).

Results

We analyzed 170 questionnaires from the EMDs of all Italian regions. A US scanner is present in 64.7% of the ERs, emergency US (E-US) is practiced only in 47.6% of the ERs, and only in 24% of these more than 60% of the ER team members have training in US. The diffusion of US in other operative units of the EMDs ranges from 8.2% to 26.5%.

Discussion

The presence of a US scanner in the ER is essential for the practice and training and is correlated with the level of the EMD. The use of US appears to be less common in less equipped hospitals, regardless of the size of the ER and the availability of radiological services. Wider diffusion of US and greater integration with other services for the installment of the required equipment is to be hoped for.     

Implementing a Human Trafficking Educational Module and Protocol in the Emergency Department

IntroductionThe purpose of this quality improvement initiative was to educate emergency nurses and social workers about human trafficking and implement a human trafficking screening, management, and referral protocol adapted from the National Human Trafficking Resource Center.MethodsA human trafficking educational module was developed and delivered at a suburban community hospital emergency department to 34 emergency nurses and 3 social workers through the hospital’s e-learning platform, with learning outcomes evaluated via a pretest/posttest and program evaluation. The emergency department electronic health record was revised to include a human trafficking protocol. Patient assessment, management, and referral documentation were evaluated for protocol adherence.ResultsWith established content validity, 85% of nurses and 100% of social workers completed the human trafficking educational program, with posttest scores being significantly higher than pretest scores (mean difference = 7.34, P ≤ .01) along with high (88%-91%) program evaluation scores. Although no human trafficking victims were identified during the 6-month data collection period, nurses and social workers adhered to the documentation parameters in the protocol 100% of the time.DiscussionThe care of human trafficking victims can be improved when emergency nurses and social workers can recognize red flags using a standard screening tool and protocol, thereby identifying and managing potential victims.     

126例严重多发伤的急诊救治

目的 探讨严重多发伤急诊科救治的重要性.方法 回顾性分析总结2003年3月至2007年6月4年多126例严重多发伤病人急诊救治的过程及要点.结果 本组126例抢救成功109例,成功率80.2%;死亡17例,死亡率19.8%.结论 多发伤在复苏、抗休克的同时尽可能的快速作出诊断,缩短中间环节,快速启动救命的手术程序,是提高抢救成功率的关键.