不同危重病情评估系统在急性消化道出血患者中的应用

急性生理与慢性健康状况评分Ⅱ( APACHEⅡ)评价系统是目前评价危重病患者病情进展及预后的第二代评分系统[1]. 简化生理学评分Ⅱ( SAPS Ⅱ)属于第三代危重病学评价系统,两者均能有效评价危重病患者病情进展,同时能对患者病死风险进行评估[2]. 但有学者[3]认为,与第三代危重病学评分系统相比,第二代评分系统更能有效预测急诊患者病情进展. 本研究将探讨 SAPSⅡ评分系统及 A-PACHEⅡ评分系统对急诊消化道出血患者病情评估的预测价值,旨在更好地评价消化道出血患者死亡风险,降低患者死亡率.     

急诊分诊快速评分对老年患者病情评价

目的：探讨快速评分方法在急诊老年患者分诊中的应用价值,为急诊老年患者就诊分诊提供依据。方法：选择北京朝阳医院急诊科2009年6月～2010年3月在急诊首次就诊年龄〉65岁的老年患者1 676例,急诊分诊时记录患者的体温、血压、心率、呼吸频率以及格拉斯哥昏迷指数,并进行急诊分诊评分。随访所有患者,对24 h在急诊医师的帮助下的患者进行APACHEⅡ评分以及记录患者的就诊转归,进一步分析急诊分诊评分与APACHEⅡ评分以及患者不同就诊转归的相关性。结果：1 676例急诊就诊的老年患者中,急诊分诊评分≥4分的患者有544例（A组）,APACHEⅡ评分平均分值为（22.31±11.25）;2～3分的患者854例（B组）,APACHEⅡ评分平均分值为（12.55±10.17）;≤1分的患者278例（C组）,APACHEⅡ评分平均分值为（6.95±8.22）。急诊分诊评分与APACHEⅡ评分具有相关性（r=0.854,P=0.012）。1 676例24 h就诊转归的患者中,离院1 122例,急诊分诊评分为（1.04±2.54）;在院554例,急诊分诊评分为（3.75±1.44）,两组比较差异有统计学意义（t=2.33,P=0.031）。结论：快速急诊评分应用于急诊老年患者分诊可评估患者病情价值,利于分诊工作,并且对患者24 h转归具有预测作用。     

快速评分方法在急诊老年患者分诊中的应用

目的分析快速评分方法对急诊老年患者分诊的重要价值。方法选取2012年3月-2015年3月期间我院急诊科共收治的急诊老年患者980例,随机将其分为对照组和观察组,对照组490例患者进行常规急诊分诊,观察组患者490例患者运用快速评分法进行急诊分诊,对比两组分诊方式在急诊分诊患者管理中的应用价值。结果对照组患者中,由于分诊不准确进行二次分诊的患者为43例,观察组二次分诊的患者为9例,两组对比差异有统计学意义(P0.05);对照组医务工作者满意度调查为77.96%,观察组医务工作者满意度调查为96.33%,两组对比差异有统计学意义(P0.05)。结论快速评分法在急诊老年患者分诊中具有重要价值,可快速评估病情,提高医务工作者对急诊分诊的满意度。     

改良儿童早期预警评分在急诊预检分诊及病情分级中的应用

目的 探讨改良儿童早期预警评分 (modified pediatric early warning score, MPEWS) 在急诊预检分诊及病情分级中的意义.方法 选取2017年2月至2018年1月来昆明市妇幼保健院急诊室就诊患儿作为研究对象, 按照要求现场采集相关数据, 急诊分诊护士对就诊患儿进行MPEWS评分, 医师就诊按5级病情分级法对患儿进行病情评估和分级, 寻求MPEWS评分值与病情危重程度的关联度.结果 MPEWS评分与病情分级之间存在相关性 (rs=-0.630, P<0.001) , MPEWS评分越高, 病情分级等级越低, 病情严重程度更高.受试者工作特征 (ROC) 曲线下面积0.996, 90%可信区间为0.9930.999 (P<0.05) , 说明MPEWS评分对重症患儿的判断有统计学意义.最佳临界值为4.5分, 此时敏感度为96.0%, 特异度为99.9%.结论 MPEWS评分对急诊预检分诊及评估儿科急诊患者病情、及时识别危重患儿有一定价值.     

急诊接诊护士应具备的素质

急救中心是抢救危急重症患者的场所，这里病人多，病情重，病种复杂，面对急诊病人，能否快速作出判断和救诊，查找关系到病人的生命安全。为满足患者和家属的需求，快速进行分诊，我科特设急诊接诊服务，对急诊病人根据病情快速分诊大大改善了急诊就诊秩序，面对复杂的急诊患者，分诊护士在短时间内快速分诊，应具备良好的素质才能胜任。     

儿科急诊潜在危重病患儿临床处理流程及管理方法研究

目的研究儿科急诊潜在危重病患儿的处理流程以及管理方法。方法该院儿科急诊于2016年5月开始实施优化的潜在危重病的早期识别及处理流程系统,于实施前(2015年1月至2016年4月)、实施后(2016年5月至2017年8月)儿科急诊收治的患儿中各随机抽取出50 000例,收集实施前后患儿的死亡率、候诊时间、分诊准确率以及家属对护理服务的满意度。结果实施优化的潜在危重病的早期识别及处理流程系统后,儿科急诊患儿的死亡率从0.218%降至0.07%,分诊准确率从99.758%提高到99.874%,且候诊时间显著缩短,比较差异有统计学意义(P 0.05);实施后家属对急诊护理的满意度从99.504%提高到99.798%,比较差异有统计学意义(P 0.05)。结论优化儿科急诊的潜在危重病早期识别及处理流程系统,强化对潜在危重病的早期识别和处理管理,缩短患儿的候诊时间,使患儿在第一时间获得最佳的救治,改善预后,值得推广。     

急诊病情报告卡在急诊分诊和处理中的作用研究

目的探究急诊病情报告卡在急诊分诊和处理中的作用。方法选取2019年5月至2019年10月潍坊市某三级甲等综合性医院的急诊就诊患者400例和急诊科医护人员11名、急诊科室主要管理人员10名作为研究对象,2019年5月至2019年7月收治的急诊患者200例作为对照组,2019年8月至2019年10月收治急诊患者200例为观察组。对照组采用常规预检分诊模式分诊,观察组采用急诊病情报告卡分诊。比较两组急诊患者误诊率、漏诊率、急诊患者分诊时间及医患满意度。结果观察组急诊患者误诊率、漏诊率、急诊患者分诊时间显著低于对照组,差异有统计学意义(P<0.05),医患满意度明显高于对照组(P<0.05)。结论急诊病情报告卡提高了急诊患者病情分级的准确率和效率,符合急诊患者的分诊时间期望,提高了急诊分诊的满意度。     

急诊分诊技巧

目的探讨急诊分诊技巧。方法对到达急诊室的病人，护士应用医学知识和一定的沟通协调能力对病情作出初步判断，迅速分诊和抢救。结果应用急诊分诊技巧可以大大提高分诊正确率。为病人赢得抢救时机。结论急诊分诊是一门学问，是项有挑战性的工作，只有不断积累工作经验，掌握工作技巧，才能更好地服务病人。     

改良早期预警评分系统在急诊分诊患者管理中的应用价值

目的:分析改良早期预警评分系统(MEWS)在急诊分诊患者管理中的应用价值。方法:选取100例急诊患者作为研究对象,按照随机数字表法分为对照组和观察组各50例,其中,对照组实施常规院内急诊分诊流程处理,观察组采用MEWS流程处理,比较两组患者分诊质量和不良事件发生率。结果:观察组各项分诊管理质量评分高于对照组,差异均有统计学意义(P<0.05);观察组患者不良事件发生率为10.00%,低于对照组的26.00%,差异有统计学意义(P<0.05)。结论:MEWS系统运用于急诊分诊患者中,可提升分诊正确率,减少不良事件发生率。     

JCI标准下急诊预检分诊制度的实施与体会

目的:通过制定和实施急诊预检分诊标准及分诊制度,提高护士分诊准确率。方法:根据生命体征、血氧饱和度、疼痛评分等制定预检分诊标准,分诊护士依据标准将患者病情分成(Ⅰ～Ⅳ)类,并迅速将患者安置在相应的抢救区域进行救治。结果:实施新的分诊标准与流程后,提高了分诊准确率,复苏室及抢救室利用率显著提高,危重病人漏诊事件明显减少。结论:急诊预检分诊制度的实施使护士能够准确地掌握具体的量化指标,提高分诊准确率,为抢救病人赢得宝贵的时间。     

急诊预检分诊系统在医院的移动应用研究

移动医疗应用是医院实施数字化医院的重要探索。分析了在医院发展创新移动医疗应用的技术环境和业务环境,并以急诊预检分诊系统为切入点,详细阐述了基于移动应用的急诊预检分诊系统的设计,并结合实践效果给出了发展移动医疗应用的展望。     

Triage: a working solution to overcrowding in the emergency department

Recently, emergency departments across the continent have become crowded with patients requiring non-urgent care. To alleviate this situation at The Hospital for Sick Children in Toronto, receptionists in the emergency department direct patients requiring urgent care to the emergency room and those requiring non-urgent care to a screening clinic (triage). During a two-month period, 13,551 patients visited the emergency department. The triage receptionist sent 8368 patients to the emergency room and 5183 to the screening clinic. About 45% of patients visiting the emergency room had suffered accidents and injuries, and 19% had respiratory illness; 15% of patient visits resulted in admission to hospital. In contrast to this, 49% of patients sent to the screening clinic had respiratory illness and 18% had infective disease; less than 1% of patients needed hospitalization.     

急诊内科危重病指征探讨

目的：探讨急诊内科危重病的指征。方法：对４２２例急诊危重病人的主要危重病指征进行分析。结果：急诊内科危重病最常见的指征是昏迷、呼吸困难和大出血。结论：掌握急诊内科危重病指征对于及时识别危重病人很重要。     

急诊护士预检分诊能力调查及影响因素分析

目的 调查急诊护士预检分诊能力，探讨其影响因素，为急诊科护士的培养提供参考依据。 方法 采用随机抽样法选取杭州市三甲医院急诊预检护士177人为研究对象，调查其预检分诊能力，并分析影响急诊护士预检分诊能力的影响因素。 结果 177名急诊护士预检分诊能力总得分最小值101分，最大值214分，平均得分(157.80±26.42)分，其中认知行为、经验及技术信心、直觉和批判性思维等4个维度评分分别为(35.09±7.11)分、(47.37±7.29)分、(27.54±6.43)分和(47.78±8.50)分；单因素分析显示，急诊工作年限、预检分诊工作年限、学历、职称、是否取得急诊相关证书、是否经过急诊分诊正规培训、是否参加病例讨论以及考核间隔是影响急诊护士预检分诊能力的主要因素(P<0.05)。Logistic多因素回归分析显示:预检分诊工作年限、学历、职称、是否经过急诊分诊正规培训、是否参加病例讨论以及考核间隔是急诊护士预检分诊能力的独立影响因素(均P<0.05)。 结论 急诊护士预检分诊能力总体处于一般水平，工作时间短、学历及职称低、未经过急诊分诊正规培训、不参加病例讨论和考核间隔较长的护士预检分诊能力较差。      

儿童医院急诊信息系统的设计与应用效果评价

目的:为了解决某三甲儿童医院急诊科分诊缺少系统支撑,精细化管理缺少数据支撑的现状。方法:结合急诊分诊指南以及院内临床专家经验设定了儿科分诊分级标准,构建了信息系统。结果:通过统计2019年2月1日至8月31日,并对比2018年同期数据发现:分诊平均耗时为49 s;患者急诊滞留平均时间缩短了65 min;降低了急诊抢救室患者死亡率0.02%;患儿年龄段主要集中在7个月至6岁,其中肺炎、抽搐待查及发热待查是最为常见的就诊原因;每日的12-13点为就诊高峰期。结论:智能分诊系统的应用,提高了急诊的服务质量以及患者满意度;同时通过分诊数据的支撑分析,有利于合理安排医疗资源。     

医院分诊排队原理的分析比较和实践

利用计算机技术．针对不同分诊管理模式分别采用不同的分诊排队方案解决，如挂号处分诊、护理站分诊、二次候诊等方法进行自动分诊排队，分别解决了成人门诊、儿童门诊、儿童急诊等不同环境下的病人分诊问题，提高了工作效率，减少了病人排队次数和时间，保证了公正公平合理的等候秩序。     

小儿危重病护理评分法对于小儿护理的干预指导研究

目的:研究小儿危重病护理评分法对于小儿护理的干预指导。方法:选择危重患儿75例,分为观察组和对照组,观察组应用小儿危重病护理评分法评分后实施相应的护理,对照组采用正常危重护理。结果:观察组症状缓解比对照组快,差异有统计学意义(P<0.05)。结论:小儿危重病护理评分法在小儿临床危重护理中,可预先知道病情发展,对治疗和预后有重要指导意义。     

Triaging self-referred patients attending ophthalmic emergency room

Objectives:

To introduce an effective and safe ophthalmic triaging system to be used by non-ophthalmologists.

Methods:

A modified scoring triage system with more relevant clinical symptoms and signs from a previously published Rome Eye Scoring System for Urgency and Emergency (RESCUE) was evaluated over a 2-month period. The study was conducted following a prospective cohort design between March and September 2014 at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Only self-referred patients were included. Its reliability in differentiating urgent and semi-urgent conditions from non-urgent conditions, identifying patients who need immediate intervention, and decreasing the waiting time were tested using Mann Whitney U test.

Results:

A total of 531 patients were included in the validation phase to evaluate the triaging system reliability, and 824 patients were included in the implementation phase (applying the system in the ophthalmology emergency room). The sensitivity to differentiate urgent and semi-urgent conditions from non-urgent conditions improved from 90.7 to 98.7%, while the specificity decreased from 97.2 to 87% compared with RESCUE. The sensitivity in differentiating urgent conditions from semi-urgent and non-urgent conditions was 99%, and the specificity was 90%. Mean waiting time reduced from 58.23 minutes to 46 minutes (p=0.014), and the median waiting time reduced from 46 minutes to 33 minutes (p=0.009).

Conclusion:

This triage system appears to be safe and effective in recognizing the urgency of different ophthalmic conditions, reducing unnecessary ophthalmic emergency load and waiting time significantly.The ophthalmology emergency room (OER) receives patients from different referral sources; such as self-referred, referral from general practitioners, optometrists, or other secondary or tertiary hospitals.1 The number of self-referrals in a dedicated OER was found to be as high as 89% of the patients who attended the OER.2 One major reason for a loaded emergency room (ER) by patients is expected to be related to receiving large number of patients with non-emergency conditions. Only 25% of patients presenting to the ER were found to have urgent medical conditions by using a triaging process.3 Emergency room visits by patients with non-urgent conditions contributes to long waiting times and patients’ frustration with the service.4 Handling an acute ophthalmic condition is different from the management of general acute medical conditions. It can be challenging for general emergency physicians and nurses to manage patients with ophthalmic complaints, because there are many acute ophthalmic conditions that can be vision threatening without obvious clinical findings.5 Therefore, because of the unique presentations of acute ophthalmic conditions, it might be risky to manage the situation entirely by general medical doctors.6 Considering such conditions, a reliable ophthalmic triaging system would be of great benefit for non-ophthalmologists working at acute care services to manage peculiar presentations of some of the acute ophthalmic problems. Limited literature exists on OER triage. Further research in this area including triage scales, facilities for triage, qualifications, and experience of triage personnel, triage standards, and guidelines are needed. Revisions of the triage criteria should focus on reducing the unnecessary use of emergency services without compromising the clinical safety.7 A recent study carried out in King Abdul Aziz University Hospital’s OER in 2013 during the month of July found that 1,094 self-referred patients were seen during that month. Out of those 1,094 patients, 712 (65.1%) were found to have non-urgent conditions after they were examined by the OER doctors.8 Lack of an appropriate triaging system for OER with high sensitivity has drawn our attention to address this urgent need for developing a new ophthalmic triage system. We introduce here a newly developed ophthalmic triage system, which gives the priority to emergency patients to be attended first among self-referred patients presenting to the OER. Our proposed ophthalmic triage system is a modified version of the Rome Eye Scoring System for Urgency and Emergency (RESCUE).9 The modification was carried out to overcome some of the limitations of the RESCUE; such as the considerable potential to miss patients with serious ophthalmic conditions as the sensitivity was only 90.7%, and not including important clinical parameters that are known to be the presentations of serious ophthalmic emergency conditions. The main objectives of this project were to evaluate the effectiveness of the newly modified ophthalmic triage system on recognizing patients with emergency ophthalmic conditions and giving the priority to patients according to the level of urgency of the ophthalmic condition.     

检伤分类在印尼海啸危重伤员转运中的应用

目的探讨检伤分类在地震、海啸灾区转运危重伤员中的作用。方法在印尼亚齐地震海啸灾区救援中,运用检伤分类筛选危重伤员并航空转运到亚齐机场,机场多国联合转运中心对危重伤员采取急救医疗措施并依据检伤分类结果确定后送次序。结果共计对217名伤员进行检伤分类、快速处置并转运后送。结论检伤分类可有效利用有限的医疗资源,最大限度救治危重伤员。