非战争军事行动方舱医院门急诊管理模式探讨

目的:探讨非战争军事行动野战方舱医院门急诊管理模式.方法:施行门急诊分开式统一管理,成立急诊绿色通道,急诊帐篷连接通道舱,绿色通道医生实行24h工作制.门诊设单独帐篷,由高年资主治医师以上专科医生出正常门诊.由门急诊主任及护士长统一协调管理.结果:某部野战方舱医院在2008年赴四川绵竹,2010年赴玉树抗震救灾执行任务中,采取此门急诊管理模式,对患者的预控、分诊、治疗、技术操作和抢救等做到了救治质量零缺陷.结论:这种门急诊分开式统一管理、成立急诊绿色通道的模式,适应非战争军事行动野战方舱医院的门急诊管理,极大地提高了野战方舱医院的救治力.     

重症救治方舱结构布局优化设计研究

目的:针对重症救治方舱对危重伤病员实施紧急救命处置的功能需求,研究一种优化的重症救治方舱结构布局方案,使其能够有效地实施快速、持续、综合的急救功能。方法:在总结分析二代方舱医院不足的基础上,系统梳理卫生装备构成体系和医疗设备配置方案,通过方案布局比较,实现重症救治方舱结构布局优化设计的目的。结果:重症救治方舱形成了一种以急救设备集成吊塔为核心功能区的优化方案,并进一步开展了方舱的试制。结论:优化后的重症救治方舱与前两代重症救治方舱相比,操作使用更加便捷,更加有利于开展急救处置等医疗作业,增强了重症救治方舱的救治能力。     

“和平使命-2009”中俄联合反恐演习方舱医院展开配置及分析

介绍了＂和平使命-2009＂中俄联合反恐演习中医疗救治保障任务的基本情况,根据野营村场地及实际保障任务需要,重点阐述了方舱医院展开配置以及展开配置分析,并对方舱医院进行合理地布局,确保了方舱医院在规定的范围内展开,圆满完成了保障任务。     

野战方舱医院抗震救灾妇产专业模块化抽组体会

目的:探讨野战方舱医院妇产模块化人员及装备的配置。方法:结合某野战方舱医院参加四川汶川及青海玉树抗震救灾,在灾区设立妇产模块,成立妇产科门诊及妇产科检查室。结果:在汶川和玉树抗震救灾中,通过设立妇产科模块,极大地提高了灾区妇产科伤病员的诊治水平。结论:野战方舱医院设立妇产科模块,是适应野战方舱医院执行抗震救灾的需要。     

综合医院门急诊呼吸道传染病医院感染管理干预效果研究

目的 通过比较实施干预措施前后门急诊医务人员呼吸道传染病医院感染预防控制知识、管理和措施实施的变化,评价干预措施对提升门急诊呼吸道传染病医院感染预防控制能力的效果。方法 在某三级甲等综合医院成人门诊、儿科门诊和急诊实施包括修订相关制度、加强制度的督导和落实、开展全员的培训和宣传等措施,比较干预措施实施前后医务人员知识水平、预防控制措施的实施、预检分诊实施率的变化,评价上述综合干预措施的有效性。结果 通过实施干预措施完善了门急诊呼吸道传染病医院感染预防控制的制度流程、改进了管理模式,预检分诊实施人员的知识水平,平均得分从实施干预措施前的(5.54±1.36)分提升至(6.64±1.86)分,效果显著(t=-4.90,P<0.01);预检分诊实施率从实施干预措施前的48.10%提升至70.95%(χ2=31.50,P<0.01)。结论 完善呼吸道传染病医院感染预防控制的制度、加强制度的督导和落实,开展全员的培训和宣传等措施能有效提升综合医院门急诊呼吸道传染病医院感染的预防控制能力。     

野战方舱医院在五官模块抗震救灾中的应用及体会

目的:探讨野战方舱医院五官模块在抗震救灾中的使用。方法:根据野战方舱医院参加抗震救灾五官科遂行的卫勤保障任务,对实际展开工作的特点及遇到的困难,以及针对五官科模块配置装备少、需多渠道筹措等情况进行分析。结果:野战方舱医院配置使用五官模块,在参加汶川抗震救灾和玉树抗震救灾中提高了方舱抗震救灾保障能力。结论:野战方舱医院使用五官模块,适应抗震救灾需要,极大提高了野战方舱医院的救治能力。     

急诊预检分诊制度的探讨

预检分诊标准直接影响绿色通道的救治质量。在研究国内外急诊预检分诊制度的基础上,结合实际,对急诊布局和预检分诊实践进行了探讨。     

非战争军事行动方舱医院的抽组与部署

结合抗震救灾等非战争军事行动的任务和要求,总结了方舱医院执行非战争军事行动卫勤保障任务的主要特点。从理解行动任务、明确抽组任务,针对现实特点、确立抽组目标,科学抽组力量、适应不同行动要求等方面阐述了方舱医院的抽组方法;从针对任务样式、灵活配置部署,快速优先部署方舱医院、提高救治能力,慎重初次配置、快速机动展开等方面阐述了方舱医院的部署方法。指出正确把握方舱医院的合理抽组和部署方法,赢得了救治时间,提高了救治能力,确保了救治效果。     

急诊分级分诊救治模式在急性脑卒中救治中的价值及对医疗纠纷率的影响

目的:研究急诊分级分诊救治模式在急性脑卒中救治中的价值及对医疗纠纷率的影响。方法:选择2018年1月至2020年1月期间收治的70例急性脑卒中患者为研究对象,按随机数字表法分为观察组(n=35)和对照组(n=35)。观察组采用急诊分级分诊救治模式,对照组采用常规急诊救治模式,对两组患者接诊到确诊花费时间、救治效果、医疗纠纷发生率及患者家属满意度进行比较分析。结果:观察组候诊、治疗等候及急诊救治时间均短于对照组(P<0.05);观察组救治成功率与满意度均高于对照组,而漏诊率、医疗纠纷发生率均低于对照组(P<0.05)。结论:对于急性脑卒中救治干预中开展急诊分级分诊救治模式,患者整体救治成功率显著提升,医疗纠纷发生情况减少。     

JCI认证中门急诊管理实践

镇江市第一人民医院依托信息技术完善了急诊预检分诊体系，急诊预检分诊信息系统的使用提高了分诊工作效率，避免了因病情复杂、症状不典型等因素造成的人为差异；优化了门急诊危急值报告流程，通过优化门诊危急值报告流程，不仅可以将危急值第一时间通知患者，而且减少了医生的工作量，提高了工作效率；创建了基于二维码的门急诊病人的自我评估系统，患者自我评估系统的使用，提升了患者主动参与诊疗的积极性；通过门诊概况对患者以往就诊信息进行全面回顾，便于医生全面了解患者病情；规范了门急诊高危药品的管理，提高了患者用药安全。通过门急诊流程的优化改造，门急诊管理上了一层台阶，在患者安全服务质量方面取得了一定的成效。     

Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting

PROBLEM: Early assessment, prioritization for treatment and management of sick children attending a health service are critical to achieving good outcomes. Many hospitals in developing countries see large numbers of patients and have few staff, so patients often have to wait before being assessed and treated. APPROACH: We present the example of a busy Under-Fives Clinic that provided outpatient services, immunizations and treatment for medical emergencies. The clinic was providing an inadequate service resulting in some inappropriate admissions and a high case-fatality rate. We assessed the deficiencies and sought resources to improve services. LOCAL SETTING: A busy paediatric outpatient clinic in a public tertiary care hospital in Blantyre, Malawi. RELEVANT CHANGES: The main changes we made were to train staff in emergency care and triage, improve patient flow through the department and to develop close cooperation between inpatient and outpatient services. Training coincided with a restructuring of the physical layout of the department. The changes were put in place when the department reopened in January 2001. LESSONS LEARNED: Improvements in the process and delivery of care and the ability to prioritize clinical management are essential to good practice. Making the changes described above has streamlined the delivery of care and led to a reduction in inpatient mortality from 10-18% before the changes were made (before 2001) to 6-8% after.     

思维导图预检分诊培训在急诊护理人员中应用效果分析

目的探讨急诊护理人员应用思维导图预检分诊培训的效果。方法选取2018年1月—2019年1月在该院急诊工作的护理人员23名作为对照组,并选择2019年2月—2020年2月在该院急诊工作的护理人员23名作为试验组。对照组实施传统分诊培训模式,试验组实施思维导图预检分诊培训,对比两组培训后的预检分诊总分及预检分诊中各维度评分。结果试验组预检分诊总分显著优于对照组,差异有统计学意义(P<0.05);试验组认知行为、直觉、经验和技术信心及评判性思维等预检分诊项目评分显著优于对照组,差异有统计学意义(P<0.05)。结论在急诊护理人员中应用思维导图预检分诊培训,显著提高预检分诊效率,同时提高护理人员在工作中的决策能力。     

大型综合医院新型冠状病毒肺炎流行期间门急诊与住院患者的管理实践

目的探讨在新型冠状病毒肺炎(COVID-19)流行期间门急诊与住院患者的管理,旨在有效阻断新型冠状病毒在医院内的传播流行。方法从传染病管理三要素"控制传染源、切断传播途径、保护易感人群"入手,分别对预检分诊、发热门诊及病区住院患者从发热筛查、接诊管理、人员防护、住院管理、应急处置、陪护管理、环境消毒等方面做出具体指导。结果门急诊患者与住院患者经过有效的筛查及合理的接诊、医务人员经过科学的防护、陪护人员经过有效的控制,新型冠状病毒感染流行期间未出现医护人员及住院患者的院内感染事件。结论某大型综合医院的门急诊与住院患者管理策略可为其他综合性医院制定疫情防控策略提供科学参考依据。     

Efficacy of the emergency unit's filter function in patients with psychiatric symptoms

The fundamental functions of the recently established emergency units/departments include the initial assessment, triage, commencement of treatment and referral for admission to the hospital. Aim: The aim of the study was to analyze psychiatric cases assessed at the department of emergency with particular reference to misdiagnoses and the reasons why emergency physicians failed to reach correct diagnoses. Method: This is a chart review of patients with psychiatric diagnoses evaluated at the Department of Emergency, Mohács City Hospital during 2006. These patients were followed through the electronic database of the hospital and their socio-demographic and clinical characteristics were analyzed. Results: Of the 596 patients who were considered primarily psychiatric cases during 2006, 289 (49%) were admitted to the psychiatric ward, 182 (30%) were referred to outpatient treatment, and 125 (21%) were misdiagnosed and proved to be non-psychiatric emergencies and eventually ended up in other wards (75 patients in internal medicine, 20 in neurology, 12 in intensive care, and 18 in other units). Conclusion: Overall, the diagnostic and triage functions of the department of emergency were satisfactory in psychiatric cases. Medical emergencies that were frequently mistaken for psychiatric cases (e.g. atypical pneumonia, sensory aphasia) deserve particular attention. The authors emphasize the importance of the close collaboration of different medical areas involved in emergency assessment and treatment.     

一种新型手术/急救医疗方舱方案探讨

目的：研究一种新型手术/急救医疗方舱,使该舱在方舱医院系统模块化组合中更加灵活,有效减少装备数量.方法：分析原方舱医院中手术方舱和急救方舱的功能、配置和布局,从医学勤务布局等方面探讨手术/急救方舱复合的可能性.结果：将手术/急救2种功能集中在1个方舱内方案可行.在抽组30张床位的移动方舱医院时,较原方舱医院减少了方舱模块,床位配置更加合理.结论：开展手术/急救方舱功能研究,能保证在满足原方舱医院战技指标的情况下,使得方舱医院抽组更加合理,使用更加方便,机动性大大提高.     

‘Why must I wait?’ The performance of legitimacy in a hospital emergency department

This article examines the processes of negotiation that occur between patients and medical staff over accessing emergency medical resources. The field extracts are drawn from an ethnographic study of a UK emergency department (ED) in a large, inner city teaching hospital. The article focuses on the triage system for patient prioritisation as the first point of access to the ED. The processes of categorising patients for priority of treatment and care provide staff with the opportunities to maintain control over what defines the ED as a service, as types of work and as particular kinds of patients. Patients and relatives are implicated in this categorical work in the course of interactions with staff as they provide reasons and justifications for their attendance. Their success in legitimising their claim to treatment depends upon self‐presentation and identity work that (re)produces individual responsibility as a dominant moral order. The extent to which people attending the ED can successfully perform as legitimate is shown to contribute to their placement into positive or negative staff‐constituted patient categories, thus shaping their access to the resources of emergency medicine and their experience of care.     

急诊科分诊及预见性护理

目的探讨急诊科分诊和预见性护理在临床应用的效果。方法回顾性分析该院急诊科2011年6—12月实施传统护理的368例患者和2012年1—6月急诊科护理实施预见性护理的412例患者,分别是定为对照组和实验组,观察分诊准确率,并发症和病死率。结果实验组患者的分诊情况、并发症发生率和死亡情况均较对照组有明显改善和提高,两者存在明显差异性。结论急诊科患者实行急诊分诊和预见性护理,有效地降低了致残率和并发症的发生,提高了治疗和护理的效果。