急诊科护士职业压力分析及干预措施研究

目的 研究急诊科护士的职业压力状况,寻求缓解或排除其压力的方法。方法 选取上海市第六人民医院急诊科的护士48名作为研究对象,采用常规心理辅导、帮助护士减轻和消除压力、提高急诊科护士的适应能力的方法进行适当干预,干预前和干预3个月后分别采用抑郁自评量表（SDS）、焦虑自评量表（SAS）和护士职业压力源量表来客观表达急诊科护士身心受压的情况。结果 干预后,急诊科护士抑郁和焦虑发生率均低于干预前（0 vs 33.33%,0 vs 22.92%）,差异具有统计学意义（P＜0.05）。干预后,急诊科护士SDS和SAS评分均低于干预前［（37.73±7.12）分 vs （46.22±6.75）分,（32.04±4.32）分 vs （44.18±6.39）分］,差异具有统计学意义（P＜0.05）。干预后,急诊科护士职业压力源量表中工作环境及资源方面、患者护理方面、管理及人际关系方面的问题评分均改善,差异具有统计学意义（P＜0.05）,但对于护理工作方面、工作量及时间分配的问题评分无改善,差异无统计学意（P＞0.05）。结论 护理管理中应充分重视应对护士的职业压力,采取合理的干预措施,营造一个融洽、和谐的工作环境,促其身心健康发展。     

2014~2017年我院急诊科患者特点分析

目的 分析我院急诊患者分布特点,加强我院急诊科科学管理,为急诊患者提供高效及时的急诊诊疗服务。方法 将2014年1月~2017年12月来我院急诊就诊患者的数据进行整理,分析我院急诊患者就诊特点和规律。结果 急诊患者多在30~59岁;每年1、2月急诊患者较多;每天急诊患者就诊集中在18:00~20:59时段;急诊患者以循环系统疾病、神经系统疾病、呼吸系统疾病、消化系统疾病、外伤为主;急诊死亡以循环系统疾病、神经系统疾病为主。结论 根据急诊患者就诊时间分布,对医院急诊科医护人员及医疗药品设备进行合理的安排和利用,避免因医护人员不足或药品设备提供不及时而产生的差错事故,从而提高急诊科医疗服务质量。     

A Prospective,Non-interventional Study of Assessment and Treatment Adequacy of Pain in the Emergency Department of a Tertiary Care Cancer Hospital

Introduction:

Pain is the most common reason for emergency department (ED) visits by the cancer patients. Treatment inconsistency and inadequacy are reported worldwide in the management of ED pain. We conducted a non-interventional observational study of 100 patients visiting ED with moderate to severe pain in a tertiary care cancer center.

Aims:

The goal of this study was to describe the characteristics of pain and its treatment by oncologists in ED.

Materials and Methods:

Management of 100 adult patients with complaints of moderate to severe pain was observed by the investigator in ED. Treatment was provided by the doctors of respective oncological services. Later, patients were interviewed by the investigator to collect data about the details of their pain and treatment adequacy.

Results:

On arrival to ED, about 65% patients reported severe pain, however no formal pain assessment was performed and no patient received strong opioids. Poor compliance for prescribed analgesic medications was noted in a large number of patients (31%), primarily due to suboptimal pain relief and lack of awareness. Protocol based analgesic treatment was non-existent in ED. Majority of patients remained in significant pain after 30 min of analgesic administration and 24% patients could never achieve more than 50% pain relief at the time of discharge.

Conclusion:

Due to lack of formal pain assessment and laid down protocols, suboptimal pain management is commonly prevalent in ED. Use of strong opioids continues to be scarce in management of severe pain. There is a need to formulate pain management protocols for ED pain.     

急诊内科老年患者疾病谱分析

目的 分析急诊内科老年患者疾病谱特点,为老年患者临床救治和地区性常见疾病防控工作提供依据。方法 选取2013年1月~2017年12月我院急诊内科收治的60岁及以上老年患者6982例,分析各年度老年患者占比情况、疾病系统分类排名、疾病系统诊断分类前3位排名、多病共存状态。结果 2013年1月~2017年12月共有12549例急诊住院患者,其中60岁及以上老年患者为6982例,占55.64%。2016年度老年患者占比低于2013~2015年度,2017年度老年患者占比高于2013~2016年度,差异有统计学意义（P＜0.05）。按照疾病系统分类排前5位的分别是呼吸系统、消化系统、循环系统、神经系统、中毒,前5位系统疾病总占比89.76%。按照疾病诊断将呼吸、消化、循环、神经、中毒系统疾病中排在前3位的疾病进行统计排位,呼吸系统排在前3位的疾病分别是:肺部感染、慢性阻塞性肺疾病、支气管炎;消化系统排在前3位的疾病分别是:胰腺炎、胃炎、胃肠炎;循环系统排在前3位的疾病分别是:冠心病、高血压、心肌病。有85.15%的老年患者存在多病共存现象,最多的达7种;其中共存2~4个系统疾病的老年患者人数最多,占71.84%。随着患者年龄增大,共存的疾病种类增多,住院时间呈增加趋势,差异有统计学意义（P＜0.05）。结论 急诊内科老年患者多以呼吸系统、消化系统、循环系统、神经系统、中毒等疾病为主,多存在多病共存现象。     

An anonymous unlinked sero-prevalence survey of HIVHCV in an urban Emergency Department

BackgroundIn 2002, the sero-prevalence of human immunodeficiency virus-1 (HIV) in the Emergency Department (ED), University Hospital, Newark, New Jersey was 10.4%. Both HIV and hepatitis C virus (HCV) are transmitted by injection drug use (IDU) or sexual contact. However, the degree of concurrent positive HCV antibody status in HIV-infected ED patients is unknown.ObjectivesIn this study we determined the sero-prevalence of HIV and HIVHCV in HIV-positive patients in the ED.Study designA cross-sectional study using an anonymous sero-prevalence survey was conducted from 7/1/2008 to 8/23/2008. Medical records were reviewed and de-identified; remnant blood specimens were also de-identified and tested for HIV antibody, and if positive, HCV antibody.ResultsOf 3488 specimens, 225 (6.5%, 95% CI: 5.7–7.3%) were positive for HIV antibody. Seventy-four patients 74/225 (32.9%, 95% CI: 33.8–46.5%) were unaware of their sero-positivity. Forty percent of HIV positive patients (90/225, 95% CI: 33.8–46.5%) were HCV antibody positive. The highest seroprevalence of HIVHCV antibody was among older patients (≥45 years), and patients with positive urine toxicology and elevated liver function tests.DiscussionGiven the high prevalence of HIV and HIVHCV antibody in the ED, routine testing is important for patients ≥45 years with positive urine toxicology and elevated liver function tests.     

应急能力培训课程设置及模式在急诊科新护士培训中的研究

目的 为了提高急诊科新护士应急能力,在课程设置及模式方面进行尝试。方法 制定培训目标,采用理论讲授,结合实践操作训练,并采用多种教学模式相结合的培训方法。结果 对急诊科新护士建立“以岗位胜任力”为重要评价结果的考试考核评价体系,对综合培训形式的过程及结果等进行针对性评价。结论 让新护士从被动接受培训到主动参与,激发其学习的积极性,帮助其自觉完成培训计划,最终使其达到职业素养、专业知识、专科技能的全面提升。     

急危重症患者家属心理需求情况调查与分析

目的：了解急危重症患者家属心理需求满足程度。方法采用自制问卷调查表对百色市两家三甲医院共136名急诊危重患者家属进行问卷调查。结果94.12%的家属对患者病情不了解;93.38%家属对治疗方案不满意;而仅7.35%家属从医生方面了解患者病情。结论急诊医护人员在抢救患者的同时应重视家属这一群体的心理需求的满足,以维护其身心健康,帮助其度过心理难关,从而有利于医患纠纷的防范。     

Using patient companions as interpreters in the Emergency Department: An interdisciplinary quantitative and qualitative assessment

ObjectivesTo explore the perceived and actual quality of communication and the conversational mechanisms through which misunderstandings arise in linguistically diverse Emergency Department consultations.MethodsA mixed method approach was used, based on audio-records of consultations which rely on patient companions for linguistic support, and ethnographic contextual data. Interpreting errors and their potential impact on the clinical reasoning process and doctor-patient relationships were quantitatively assessed. Complementary qualitative ethnographic research provided a richer understanding of the context. The study involved interdisciplinary collaboration with specialists in applied linguistics, medicine, and psychology.ResultsAccurate interpretation occurred in as few as 19% of interpreter speech turns. Answering for the patient and omitting information were the most frequent errors. The nature and severity of the impact of the errors varied. Answering for the patient had the greatest clinical impact. The omission of messages from the doctor to the patient negatively affected doctor-patient relationships.ConclusionGaps were observed between the perceived and the actual quality of communication, although patient companions often provided useful information.Practice implicationsIn addition to raising awareness among doctors on the potential risks of using AHIs, EDs should adjust their management to increase the utilization of onsite and remote PIs.     

The Importance of 4th Generation HIV Testing in an Urban Emergency Department

Early Acute Human Immunodeficiency Virus Infection (eAHI) diagnosis, via 4th generation testing methodology, presents an opportunity for earlier detection and immediate linkage to care for infected persons. We report on two patients with high-risk behaviors for HIV infection, presenting with atypical symptoms of eAHI in an urban Emergency Department (ED). This case report should raise the index of suspicion for HIV among ED physicians as well as underscore the importance of reducing HIV transmission through earlier detection. Universal screening of patients aged 13–64, incorporating new HIV diagnostic algorithms, is recommended by the Centers for Disease Control and Prevention (CDC). By employing the 4th generation HIV testing methodology, we can potentially diagnose HIV infection earlier compared to older testing methodologies. Currently, 3rd generation HIV testing is used to detect the presence of HIV antibodies, generally through an enzyme-linked immunosorbent assay (ELISA). However, detection of HIV antibodies can take anywhere from 3 to 12 weeks, depending on the individual and testing modality used. This newer diagnostic paradigm enables earlier identification of newly infected individuals. Early HIV detection allows for linkage to care and the administration of effective treatment modalities shortly thereafter. As HIV transmission is highest during its initial acquisition, early detection and linkage to care has been shown to be an efficient method to decrease transmission through subsequent changes in behaviors of those infected.     

急诊科护士对急救药物知识掌握现状分析

目的：了解急诊科护士对急救抢救药物知识的掌握情况。方法采用自设调查表,对四所三甲医院160名急诊科护士进行调查;问卷分两部分,第一部分内容护士一般情况,护士获取药物知识途径。第二部分内容为急救药物的用量剂型、药理知识、禁忌症和副作用、观察事项。结果不同年资、职称护士对急救药物知识掌握有统计学意义;护士获得药物知识的途径欠缺。结论提高急诊护士对抢救药物知识的掌握需通过全面学习达到,护士系统业务学习、说明书的解读,药物知识培训,是护士掌握抢救药物知识的有效途径。     

The Prevalence and Emergency Department Utilization of Patients Who Underwent Single and Double Inter-hospital Transfers in the Emergency Department: a Nationwide Population-based Study in Korea, 2016–2018

BackgroundInter-hospital transfer (IHT) for emergency department (ED) admission is a burden to high-level EDs. This study aimed to evaluate the prevalence and ED utilization patterns of patients who underwent single and double IHTs at high-level EDs in South Korea.MethodsThis nationwide cross-sectional study analyzed data from the National Emergency Department Information System for the period of 2016–2018. All the patients who underwent IHT at Level I and II emergency centers during this time period were included. The patients were categorized into the single-transfer and double-transfer groups. The clinical characteristics and ED utilization patterns were compared between the two groups.ResultsWe found that 2.1% of the patients in the ED (n = 265,046) underwent IHTs; 18.1% of the pediatric patients (n = 3,556), and 24.2% of the adult patients (n = 59,498) underwent double transfers. Both pediatric (median, 141.0 vs. 208.0 minutes, P < 0.001) and adult (median, 189.0 vs. 308.0 minutes, P < 0.001) patients in the double-transfer group had longer duration of stay in the EDs. Patient''s request was the reason for transfer in 41.9% of all IHTs (111,076 of 265,046). Unavailability of medical resources was the reason for transfer in 30.0% of the double transfers (18,920 of 64,054).ConclusionThe incidence of double-transfer of patients is increasing. The main reasons for double transfers were patient''s request and unavailability of medical resources at the first-transfer hospitals. Emergency physicians and policymakers should focus on lowering the number of preventable double transfers.     

急诊科护患纠纷的相关因素及预防措施

目的：通过对急诊科护患纠纷现存及潜在因素的分析,以减少急诊科护患纠纷的发生。方法对成都大学附属医院急诊科5年来发生的护患纠纷记录进行回顾研究。结果患者对医院期望过高,护士的技术水平及服务质量不足,护士本身工作压力过大,法律意识不强是急诊科护患纠纷的主要原因所在。医院应通过加强护士道德、技术和法律素质,促进护患沟通,以减少纠纷的发生。     

探讨彩色多普勒超声检查对妇产科急诊的诊断与鉴别诊断价值

目的探讨彩色多普勒超声检查对妇产科急诊的诊断与鉴别诊断价值。方法选取我院2012年6月~2013年6月接收的73例妇产科急诊患者作为观察对象,对患者的临床声像图进行回顾性分析,并进行总结。结果73例妇产科急诊患者经超声诊断结果一致的为71例,符合率为97.26%。50例异位妊娠的患者,经超声检查诊断出48例,10例急性盆腔炎全部检出,8例卵巢囊肿蒂扭转全部检出,5例卵巢囊肿破裂全部检出。结论彩色多普勒超声检查方便简单,诊断准确率高,为临床上对妇产科急腹症的诊断和治疗提供可靠依据。     

Modification and Validation of a Complaint-Oriented Emergency Department Triage System: A Multicenter Observational Study

PurposeThe objective of this study was to modify and validate an emergency department (ED) triage system with improved prediction performance on hospital outcomes by modifying the Korean Triage and Acuity Scale (KTAS).Materials and MethodsWe performed a retrospective observational study at three academic universities in South Korea. The KTAS code, determined by the chief complaint and the selected modifier of a patient, was used to derive the Modified KTAS (MKTAS). We calculated the area under the receiver operating characteristics curve (AUC) and the test characteristics to evaluate the performance of MKTAS to predict hospital mortality, critical outcome, and admission.ResultsA total of 272402 and 128831 ED visits were used for the derivation and validation of MKTAS, respectively. Compared to KTAS, MKTAS had significantly higher AUC values for the prediction of hospital mortality [MKTAS 0.826 (0.818–0.835) vs. KTAS 0.794 (0.784–0.803)], critical outcome [MKTAS 0.836 (0.830–0.841) vs. 0.798 (0.792–0.804)], and admission [MKTAS 0.725 (0.723–0.728) vs. KTAS 0.685 (0.682–0.688)]. The sensitivity for predicting hospital mortality and critical outcome, as well as the specificity for predicting admission, were significantly improved.ConclusionMKTAS was derived by modifying the KTAS, and then validated. Compared with KTAS, MKTAS showed better discriminating ability to predict hospital outcomes. Continuous efforts to evaluate and modify widely used triage systems are required to improve their performance.     

急救护理流程再造在急性心肌梗死急诊介入治疗中的作用观察

观察急救护理流程再造在急性心肌梗死急诊介入治疗中的作用。方法 选取我院2017年2月~2018年5月收治的60例急性心肌梗死急诊介入治疗患者,以随机平行方式分为观察组与对照组每组30例。观察组实行急救护理流程再造,对照组实行常规护理流程,对比两组患者的护理满意度、抢救成功率、首次医疗接触时间到心电图（ECG)时间、ECG到激活导管室时间、急诊就诊到球囊扩张时间。结果 观察组护理满意度（93.33%）,高于对照组（73.33%）,差异有统计学意义（P＜0.05）。观察组首次医疗接触-ECG时间、ECG-激活导管室时间、急诊-球囊扩张时间分别为:（5.11±1.19）min、（22.29±2.62）min、（65.11±9.98）min,高于对照组的（10.37±1.56）min、（46.32±4.84）min、（92.04±5.03）min,差异有统计学的意义（P＜0.05）。结论 急性心肌梗死急诊介入治疗中,实行急救护理流程再造,可提高急性心肌梗死患者的护理满意度和抢救成功率,减少首次医疗接触-ECG、ECG-激活导管室、急诊-球囊扩张的时间。     

89例急诊科死亡病例分析及临床意义

急诊外科作为医疗抢救过程中的一线部门,随着社会的不断进步,急诊科患者出现死亡的概率也呈现出逐年升高的趋势。导致急诊外科患者死亡的原因相对较多,这就在一定程度上增加了急诊抢救工作的难度。为了降低急诊患者的死亡率,就必须提高急诊人员的紧急事件处理能力以及反应能力,并严格遵循急诊抢救过程中的原则,以便于提高患者的抢救成功率。本研究将对89例急诊死亡患者的死亡原因进行分析,并对分析急诊患者死亡原因对急诊患者抢救过程中的帮助进行探讨。     

血清PCT、IL-6、NT-proBNP、CTnI和D-D测定水平在急诊脓毒症患者早期诊断中的临床研究

目的 为了探讨急诊脓毒症患者早期诊断中测定血清降钙素原(procalcitonin,PCT)、白介素-6(interleukin-6,IL-6)、N端脑利钠肽前体(n-terminal pro B-type netriuretic peptide,NT-proBNP)、肌钙蛋白Ⅰ(cardiac troponin Ⅰ,CTnI)和D-二聚体(D-dimer,D-D)水平的临床意义.方法 采用化学发光免疫分析、超敏酶免疫分析和荧光免疫分析测定了急诊就诊患者439例,其中307例诊断为急诊脓毒症患者(包括236例严重脓毒症和71例脓毒症休克)和普通感染患者132例,以及86例正常对照组血清生物标志物(PCT、IL-6、NT-proBNP、CTnI和D-D)水平,并进行了对比性分析.采用受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析PCT、IL-6、NT-proBNP、CTnI和D-D评估急诊脓毒症患者早期诊断的临床价值.结果 307例急诊脓毒症患者血清PCT、IL-6、NT-proBNP、CTnI和D-D水平较之86例正常对照组明显增高(P分别为＜0.001,＜0.001,＜0.01,＜0.001和＜0.001),并且随疾病严重程度而增高.132例普通感染患者血清PCT、NT-proBNP、CTnI和D-D水平正常(P均＞0.05),仅血清IL-6水平轻度增高(P＜0.05).ROC曲线对急诊脓毒症早期诊断预测的价值评估表明:五种生物标志物均具有急诊脓毒症早期诊断的价值,以PCT为最佳,其后依次为IL-6、NT-proBNP、CTnI和D-D.结论 生物标志物(PCT、IL-6、NT-proBNP、CTnI和D-D)是急诊脓毒症早期诊断和病情严重程度评估的有价值指标.