影响急腹症患者分诊准确率的因素与对策

回顾190例急腹症患者的分诊,发生分诊失误13例。造成分诊失误的因素有疾病因素、患者和家属因素及分诊护士因素。掌握急腹症分诊技巧,认真实施分诊,加强对患者和家属的宣教,制定分诊护士准入标准,提高分诊护士素质,是降低急腹症分诊失误率的有效措施。     

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。     

构建全信息化急诊预检分诊流程的实践和效果

目的 探讨集急诊分诊、信息化分析监控及挂号为一体的全信息化分诊流程的构建在急诊分诊中的应用效果。方法 设计和使用急诊分诊管理软件,在急诊分诊台由分诊护士一次性完成分诊、信息录入和挂号工作。随机抽取全信息化分诊流程实施前后各500例急诊患者就诊情况进行比较,分析分诊与挂号时间、分诊准确率及患者家属满意度、医护人员满意度情况。结果 使用全信息化分诊流程后,分诊时间减少,准确率提高,患者家属及医护人员的满意度提高。结论 全信息化分诊流程促进了急诊分诊的规范化、科学化和系统化的管理,提高了分诊效率,保障了医疗护理安全。     

粤港两地急诊分诊差异性探讨及借鉴

介绍香港急诊分诊系统,以提高急、危、重症患者的筛选率为主要目标,分诊护士将急诊患者按照病情的轻、重、缓、急进行分类,对病情危重的患者实施最快急救.香港急诊分诊指南操作性强,有具体的量化指标,分诊流程规范化,分诊设施齐全,分诊信息网络化,便于分诊护士全面的收集资料,对患者进行综合病情评估.相对而言,广东省的急诊分诊有待建立统一的分诊标准,优化分诊流程,改善分诊环境,配备完善的分诊设备,加强分诊护士的培训,从而提供更加优质安全的急诊医疗护理服务.     

提高急诊胸痛患者分诊准确率的研究

目的探讨新的分诊方法对急诊胸痛患者分诊准确率的影响。方法分别选取低、高年资分诊护士各10名,对400例以非创伤性胸痛为主诉的急诊就诊患者以分诊记录单Ⅰ和分诊记录单Ⅱ分别分诊,并记录和比较分诊结果;对分诊护士进行访谈并修改分诊记录单Ⅱ。结果使用分诊记录单Ⅱ后,低、高年资护士的分诊准确率均有明显提高(P<0.01);低年资护士的分诊错误明显多于高年资护士(P<0.01),而且错误内容不同。结论分诊记录单Ⅱ的使用可以帮助护士提高急诊胸痛患者的分诊准确率。     

急性脑卒中患者分诊效果的比较

目的：探讨急性脑卒中分诊记录单对急诊脑卒中患者分诊准确率、候诊时间以及患者满意度的影响。方法选取10名急诊科分诊护士,对120例非创伤性脑卒中患者按就诊先后顺序随机分配到对照组和实验组,对照组使用传统分诊方法进行分诊,实验组使用脑卒中分诊记录单分诊,比较两组分诊准确率、候诊时间和患者满意度。结果应用急性脑卒中分诊记录单后分诊准确率、候诊时间及患者满意度较传统分诊方法均有所改善,差异有统计学意义(P<0.05)。结论急性脑卒中分诊记录单的使用可以帮助护士提高急诊脑卒中患者的分诊准确率、缩短候诊时间,提高患者满意度。     

急性心肌梗死预检分诊失误原因分析

目的 探讨降低急性心肌梗死(AMI)预检分诊失误率.方法 回顾性分析30例AMI预检分诊失误病例的临床资料.结果 AMI预检分诊失误占同期AMI分诊总数的13.95%;不同护龄、不同学历分诊护士AMI预检分诊失误率的比较,差异有统计学意义(P＜0.05);分诊护士的护龄、学历是分诊失误的影响因素.结论 提高急诊护士临床分诊经验及专业理论水平,全面收集病史资料可有效降低AMI预检分诊失误率.     

急诊分诊管理软件的设计及应用效果

目的探讨集急诊分诊、挂号、实时分诊质量监控三位一体的急诊分诊管理软件在急诊分诊中的应用效果。方法设计和使用急诊分诊管理软件,在急诊分诊台由分诊护士一次性完成分诊、收费与挂号工作。对急诊分诊管理软件使用前后各200例急诊患者就诊情况进行比较,分析分诊与挂号时间、分诊准确率及患者与家属满意度情况。结果急诊分诊管理软件使用后,分诊与挂号时间由原先的(177.18±62.85)s下降到(30.89±10.27)s(P<0.01),分诊准确率由以前的92.5%上升到99.0%(P<0.01),患者对病情分级、分区救治、分科以及分诊与挂号流程满意率明显提高(P<0.01),但软件使用前后患者对等待就诊时间和服务态度的满意率差异无统计学意义(P>0.05)。结论急诊分诊管理软件促进了急诊分诊的规范化、科学化和系统化管理,提高了工作效率、分诊质量和患者的满意度,保障了患者安全。     

两种预检分诊模式对三级综合医院儿科急诊分诊质量的影响

目的探讨两种预检分诊模式对三级综合医院儿科急诊分诊质量的影响,建立系统化的预检分诊模式,优化分诊流程,提高分诊质量。方法将2014年1-3月在我院就诊的72 821例患儿设为对照组,采用传统预检分诊模式分诊;将2014年10-12月在我院就诊的78 135例患儿设为研究组,采用系统化预检分诊模式分诊。比较两组间的分诊准确率、抢救成功率、死亡率、纠纷发生率及候诊意外发生率。结果研究组患儿的分诊准确率为96.28%,高于对照组的81.22%;两组间抢救成功率、死亡率、纠纷发生率、候诊意外发生率等差异均有统计学意义(P0.05)。结论系统化预检分诊模式在分诊标准、分诊流程、分诊工具、人员配备等方面均有很大程度的优化,可以提高分诊准确率和抢救成功率,降低死亡率、纠纷发生率和候诊意外发生率,促进患儿就诊全过程的安全。     

中法急诊预检分诊制度对比及借鉴

介绍法国急诊预检分诊工作制度:分诊目的明确,即迅速在众多就诊病人中筛查出病情最重者;分诊标准有具体的量化指标,可操作性强;分诊设施齐全,便于护士收集客观、准确的病情信息;分诊护士经过专门培训,有资格准入制度,工作范围明确;分诊信息实施计算机网络管理,方便、快捷.通过对比,我国的急诊分诊亟待建立统一的分诊标准;配备完善的分诊器材;设立专业岗位培训,实施资格准人制度;改进分诊流程,保证病人就诊安全.     

Do Knowledge and Experience Have Specific Roles in Triage Decision‐making?

Accuracy of triage decisions is a major influence on patient outcomes. Triage nurses' knowledge and experience have been cited as influential factors in triage decision-making. The aim of this article is to examine the independent roles of factual knowledge and experience in triage decisions. All of the articles cited in this review were research papers that examined the relationship between triage decisions and knowledge and/or experience of triage nurses. Numerous studies have shown that factual knowledge is an important factor in improving triage decisions. Although a number of studies have examined the role of experience as an independent influence on triage decisions, none have found a significant relationship between experience and triage decision-making. Factual knowledge appears to be more important than years of emergency nursing or triage experience in triage decision accuracy. Many triage education programs are underpinned by the assumption that knowledge acquisition will result in improved triage decisions. A better understanding of the relationships between clinical decisions, knowledge, and experience is pivotal for the rigorous evaluation of education programs.     

智能急诊分诊诊断治疗系统的研发与应用

目的 探讨智能急诊分诊诊断治疗系统在急诊科分诊中的应用效果。方法 采取便利抽样的方法,选择某三级甲等医院400例急诊科就诊患者为研究对象,根据入院时间先后顺序将其分为对照组和观察组各200例,对照组采用常规人工预检分诊,观察组应用智能急诊分诊诊断治疗系统预检分诊,比较2组患者病情资料收集时间、分诊时间、过度分诊率及患者对护士分诊工作的满意度。结果 观察组的病情资料收集时间、分诊时间均比对照组短,差异有统计学意义（P<0.05）;观察组护士过度分诊率比对照组低,差异有统计学意义（P<0.05）;同时,观察组患者对护士分诊工作表示满意的有196例,对照组中40例患者认为分诊较慢、流程繁琐等原因,表示不满意,2组满意度的比较差异有统计学意义（P<0.05）。结论 在急诊科,结合应用智能急诊分诊诊断治疗系统,优化急诊分诊流程,快速对患者病情进行分类和归纳,减少了分诊时间,保障护士的分诊效率,从而进一步保障患者安全,提高患者的满意度。     

Decision making by emergency nurses in triage assessments

Triage assessment of patients on arrival at emergency departments involves complex decision making, resulting in categories being assigned to prioritize patients' needs for attention. The actual process of triage decision making has received limited attention. The aims of this study were to describe aspects of the triage decision-making process used by both more and less experienced nurses (n = 20) and to test the effect of uncertainty in the triage situation on the use of probability judgements (heuristics). Six triage cases based on actual triage situations were simulated to subjects, and their verbal protocols were collected. Protocols were transcribed and analysed. Main findings were: in conditions of higher uncertainty in triage situations all nurses used more probability in their judgements (t-test -2.37, df = 17, P = 0.03) with the heuristic of representativeness being relied on the most. The triage categories finally assigned for each triage situation showed no agreement on a specific triage category for each triage case and past triage experiences were used in decision making. The more experienced group reported higher estimations of correctness regarding the final category assigned, used more single previously experienced cases from memory, collected less data and made more judgements than the less experienced group. Further examination of the decision-making process of triage assessment should occur with attention to the variable use of triage categories, the role of past triage experiences in making judgements and development of triage decision rules for skilling nurses for triage.     

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.     

网络智能信息化预检分诊系统在急诊中的应用

目的:探讨网络智能信息化预检分诊系统在急诊中的应用方法及效果。方法:随机选取2014年1月1日~2016年12月31日急诊就诊患者500例为对照组,采用传统的急诊预检分诊方法;随机选取2017年1月1日~2019年12月31日急诊就诊患者500例为观察组,采用网络智能信息化预检分诊系统进行预检分诊。比较两组分诊准确率、分诊所需时间及患者就医满意度。结果:两组分诊准确率、分诊所需时间、患者就医满意度比较差异有统计学意义(P<0.05,P<0.01)。结论:网络智能信息化预检分诊系统可有效提高患者分诊准确率,缩短分诊时间,提高就医满意度。     

Triage in emergency departments: national survey

Aim. This paper reports a study the aim of which was to describe how triage‐related work was organized and performed in Swedish emergency departments. Background. Hospitals in many developed countries use some kind of system to prioritize the patients attending emergency departments. Triage is a commonly used term to refer to the process of sorting and prioritizing patients for care. How the triage procedure is organized and which personnel perform this type of work vary considerably throughout the world. In Sweden, few studies have explored this important issue. Method. A national survey was conducted using telephone interviews, with nurse managers at each of the emergency departments. The sample represented 87% of emergency departments in Sweden. Results. The findings clearly illustrate the organization of emergency department triage, focusing on personnel who perform triage, as well as the facilities, resources and procedures available for triage. However, the results indicate that work associated with such triage in Sweden is not organized in any consistent matter. In 81% of the emergency departments a clerk, Licensed Practical Nurse or Registered Nurse were assigned to assess patients not arriving by ambulance. There was also diversity in other areas, including requirements for staff to have particular qualifications and clinical experience for being allocated to triage work, as well as facilities for triage personnel assessing and prioritizing patients. The use of triage scales and acuity ratings also lacked uniformity and disparities were observed in both the design and use of triage scales. A little less than half (46%) of the emergency departments did not use any kind of triage scale to document patient acuity ratings. Conclusion. In contrast to several other countries, this study shows that Swedish emergency departments do not adhere well to established standards and guidelines about triage in emergency care. Research on emergency department triage, especially in the areas of personnel performing triage, triage scales and standards and guidelines are recommended. Relevance to clinical practice. The diversity among several aspects of nursing triage (e.g. use of less qualified personnel performing triage, the use of different triage scales) presented in the study points to a safety risk for the patients. It also shows the need of further education for the personnel in clinical practice as well as further research on triage in order to gain national consensus about this nursing task.     

Factors affecting the triage decision-making ability of emergency nurses in Northern China: A multi-center descriptive survey

IntroductionThe quality of triage decision-making is a prerequisite for priority treatment of critically ill patients and effective utilization of medical resources. Figuring out how to improve triage decision-making is still a topic around the global emergency department. Hence, this study aims to promote an understanding of triage priority care and clarify the elements influencing triage decision-making ability, offering reference for the future to improve the quality of triage decision-making.MethodA total of 404 emergency nurses from 11 tertiary hospitals in northern China were surveyed by questionnaire, of which 371 valid questionnaires were submitted (effective rate = 91.83 %). One hospital distributed the questionnaire face-to-face, and the other ten used online form.ResultPrior to occupying triage jobs, only a quarter of participants(25.30 %)were qualified. Less than half of emergency nurses (46.60 %) reported taking part in the triage training program. The emergency nurses' triage decision-making ability score was 166.50 ± 26.90(95 %CI 163.75,169.24) in northern China. Gender(P = 0.003), case discussion(P = 0.024), secondary assessment(P = 0.020)and knowledge of triage consensus(P = 0.027) are independent factors influencing triage decision-making ability.ConclusionEmergency triage practices are less implemented in northern China. The triage decision-making ability of emergency nurses in northern China is at a low level. Providing emergency nurses with diverse opportunities to develop their triage skills, finding effective triage training content, form, and frequency, strengthening implement triage consensus, and wisely managing triage nurse resources would improve triage decision-making.     

汶川地震2周2283例急诊伤员分检方案的总结与探讨

目的回顾性分析四川大学华西医院在汶川地震后采取非常规方法（传统分检方法结合灾害救援的特点）分检伤员的效果，为建立大型灾害事件伤员分检处理流程，及时合理配置医疗资源，提高医疗救援水平提供参考。方法以华西医院在震后两周内接诊的所有地震伤员的诊疗信息数据为基础，对伤员伤情严重程度和所需医疗干预的迫切程度进行分检。结果按伤情严重程度和所需医疗干预的迫切程度对伤员进行分检，使危重伤员得到了及时处理，一般伤员得到了足够重视，轻伤员被及时分流，从而充分合理地利用了医疗资源，使各类伤员都得到了最恰当的处理。结论重大灾害事件发生后，伤员分检方法的选择要因地制宜，不应局限于传统的分检方法。采用灾害救援伤员分检方式分检地震后大批伤员，可使重伤员不延误病情，轻伤员不浪费医疗资源，使有限的医疗资源得到充分合理地利用。