急诊分诊管理的研究进展

院内急救是急诊医疗服务中的复杂而又非常重要的中间环节,是完善急诊救治链的重要环节。在急诊医学飞速发展的今天,预检分诊的概念已经从简单的“分科分诊”发展到根据患者病情的轻重缓急决定提供医疗服务的优先顺序,从而帮助临床提高救治效率和成功率阻。目前,正确的应用合适的病情评估工具,迅速收集患者信息,测量相关生命体征,在最短的时间内,获得最有价值的病情信息,综合分析,作出正确的判断,按照分级标准,     

急诊预检分诊的研究现状

综述国内外预检分诊的概况,分析了我国预检分诊存在的问题及原因,提出提高预检分诊质量的对策。     

我国急诊分诊工具的研究现状与对策

分析国内急诊分诊工具的现状,找出我国急诊分诊工具存在的问题,针对不同的分诊工具提出不同的应用对策。     

急诊预检分诊的研究现状

综述国内外预检分诊的概况,分析了我国预检分诊存在的问题及原因,提出提高预检分诊质量的对策。     

急诊分诊病情四级分类法分诊标准的应用研究

[目的]探讨病情四级分类法急诊分诊标准在急诊分诊工作中的应用,探讨提高急诊分诊准确性的方法。[方法]将就诊病人分为Ⅰ级(濒危)、Ⅱ级(危重)、Ⅲ级(急症)、Ⅳ级(非急症)4级,观察实施前后急诊分诊准确率及就诊病人病情意外发生率。[结果]实施病情四级分类法急诊分诊标准后,急诊病人的分诊准确率明显提高,侯诊病人病情意外发生率明显降低(P0.05)。[结论]病情四级分类法急诊分诊标准的应用,使急危重症病人得到及时的救治,保障了急危重症病人的安全。     

优化急诊就诊流程与分诊标准的研究

[目的]优化急诊预检分诊流程,合理配置分诊护士,制订病情分诊标准,提高预检分诊的准确率,在正确的时间(分类)和正确的地点(分区)给急诊病人以正确的治疗.[方法]根据危急、危重、紧急、非紧急病情制订急诊分诊标准并实施.同时采用自行设计问卷,对前来就诊的154例病人针对急诊医疗分诊工作进行抽样调查.[结果]实施新型分诊流程后,82%就诊病人表示认同.[结论]急诊分诊标准为危急重症病人提供了最佳的就诊时间,兼顾到普通病人的利益,保证了所有急诊病人的安全就诊.分类诊治保证了安全,分区诊治保证了质量,提高了病人的就诊满意度.     

优化急诊就诊流程与分诊标准的研究

[目的]优化急诊预检分诊流程,合理配置分诊护士,制订病情分诊标准,提高预检分诊的准确率,在正确的时间（分类）和正确的地点（分区）给急诊病人以正确的治疗。[方法]根据危急、危重、紧急、非紧急病情制订急诊分诊标准并实施。同时采用自行设计问卷,对前来就诊的154例病人针对急诊医疗分诊工作进行抽样调查。[结果]实施新型分诊流程后,82%就诊病人表示认同。[结论]急诊分诊标准为危急重症病人提供了最佳的就诊时间,兼顾到普通病人的利益,保证了所有急诊病人的安全就诊。分类诊治保证了安全,分区诊治保证了质量,提高了病人的就诊满意度。     

我国二级及以上医院急诊分诊依据现状调查

目的调查国内急诊分诊执行情况及分诊依据的现状。方法采用自制调查问卷,对国内113所医院的274名急诊科护士进行急诊分诊执行情况及分诊依据现状的调查。结果目前急诊分诊护士要求不统一,急诊分诊标准存在不足,急诊分诊护士现有培训不能满足临床需要。结论我国在急诊分诊护士培养和急诊分诊标准的建立等方面尚不完善,建立统一规范的分诊标准和专职分诊护士将成为急诊分诊发展的趋势。     

我国急诊分诊模式的现状与对策

急诊分诊工作是现代急救医疗服务的重要组成部分.分诊工作是根据患者的主诉及主要症状、体征分清疾病的轻重缓急及隶属专科,进行初步诊断,安排就治程序及分配专科就诊的技术[1].所有急诊患者都要经过护士分诊后才能得到专科医生的准确救治,如果分诊错误,则有可能延误治疗时机,危及生命.由于我国现阶段急诊分诊的管理相对滞后,缺乏相应的管理制度与技术标准,不同程度地妨碍了分诊工作质量的提高[2].现就国内分诊工作状况和管理综述如下.     

急诊预检分诊系统的应用及效果评价

目的:采用急诊预检分诊系统对急诊患者进行预检分诊并进行效果评价。方法:采用方便抽样法抽取2012年1、4、8月每月100名共计300名来我院急诊就诊患者作为对照组,同样方法抽取2013年1、4、8月间来我院急诊就诊的300例患者作为实验组,实验组采用急诊预检分诊系统对患者进行预检分诊。对两组危重症患者的等候时间、意外发生率、患者和医护人员的满意度进行比较。结果:实验组危重患者就诊等候时间明显缩短,急诊患者或家属满意度较对照组高,差异有统计学意义(P0.05);实验组危重患者在候诊期间无一发生意外;医护人员对急诊预检分诊系统满意度较高。结论:采用急诊预检分诊系统能改善急诊就诊环境,缩短危重患者等候时间,降低危重患者在候诊过程中的意外发生率,使急诊就诊患者的满意度提高,急诊医护人员对此系统也有较高的评价,可在临床推广应用。     

Optimizing triage consistency in Australian emergency departments: The Emergency Triage Education Kit

Objective: The Emergency Triage Education Kit was designed to optimize consistency of triage using the Australasian Triage Scale. The present study was conducted to determine the interrater reliability of a set of scenarios for inclusion in the programme. Methods: A postal survey of 237 paper‐based triage scenarios was utilized. A quota sample of triage nurses (n = 42) rated each scenario using the Australasian Triage Scale. The scenarios were analysed for concordance and agreement. The criterion for inclusion of the scenarios in the programme was κ ≥ 0.6. Results: Data were collected during 2 April to 14 May 2007. Agreement for the set was κ = 0.412 (95% CI 0.410–0.415). Of the initial set: 92/237 (38.8%, 95% CI 32.6–45.3) showed concordance ≥70% to the modal triage category (κ = 0.632, 95% CI 0.629–0.636) and 155/237 (65.4%, 95% CI 59.3–71.5) showed concordance ≥60% to the modal triage category (κ = 0.507, 95% CI 0.504–0.510). Scenarios involving mental health and pregnancy presentations showed lower levels of agreement (κ = 0.243, 95% CI 0.237–0.249; κ = 0.319, 95% CI 0.310–0.328). Conclusion: All scenarios that showed good levels of agreement have been included in the Emergency Triage Education Kit and are recommended for testing purposes; those that showed moderate agreement have been incorporated for teaching purposes. Both scenario sets are accompanied by explanatory notes that link the decision outcome to the Australasian College for Emergency Medicine Guidelines on the Implementation of the Australasian Triage Scale. Future analysis of the scenarios is required to identify how task‐related factors influence consistency of triage.     

急诊分诊过程管理应用研究

在对国内外分诊系统进行研究的基础上结合ISO9000国际质量体系标准的过程管理，提出了分诊过程管理的方法。为分诊的发展提供一种可借鉴的管理和工作模式。     

Paramedics and triage: Effect of one training session on triage in the emergency department

This 3-stage intervention study enrolled all adult patients referred to a universitybased emergency department (ED) during randomly assigned 1-week preeducation or posteducation periods. Triage decisions recorded by ED paramedics (n=8) both before and after an educational training session were compared to decisions made by emergency physicians (EPs). Triage decisions of paramedics and EPs in the preeducation phase showed poor consistency (κ =0.317, κ=0.388). Triage decisions in the posteducation phase increased slightly but were still found to be low. On the other hand, consistency between the triage assessments recorded by paramedics and EPs of the general appearance of patients increased from low in the preeducation phase to moderate in the posteducation phase (κ =0.327, κ=0.500, respectively). The training session was associated with a slight increase in the consistency of triage decisions recorded by paramedics and EPs.     

急诊分诊过程管理应用研究

在对国内外分诊系统进行研究的基础上结合ISO9000国际质量体系标准的过程管理,提出了分诊过程管理的方法,为分诊的发展提供一种可借鉴的管理和工作模式。     

Current status of emergency department triage in mainland China: A narrative review of the literature

In this review, the current status of emergency department triage in mainland China is explored, with the purpose of generating a deeper understanding of the topic. Literature was identified through electronic databases, and was included for review if published between 2002 and 2012, included significant discussion of daily emergency department triage in mainland China, was peer reviewed, and published in English or Chinese. Thematic analysis was used to identify themes which emerged from the reviewed literature. This resulted in 21 articles included for review. Four themes emerged from the review: triage process, triage training, qualification of triage nurses, and quality of triage. The review demonstrates that there is currently not a unified approach to emergency department triage in mainland China. Additionally, there are limitations in triage training for nurses and confusion around the role of triage nurses. This review highlights that emergency department triage in mainland China is still in its infancy and that more research is needed to further develop the role of triage.