系统化预检分诊模式对儿科急诊分诊的影响

目的探讨系统化预检分诊模式对儿科急诊分诊的影响。方法选取2018年3月~2019年3月我院收治的儿科急诊就诊患儿80例,根据临床分诊模式不同将其分为对照组和观察组各40例。对照组进行传统预检分诊模式,观察组进行系统化预检分诊模式。比较两组患儿候诊意外发生、纠纷发生、死亡发生率及抢救成功情况,比较两组就诊满意率情况。结果观察组候诊意外发生、纠纷发生、死亡发生率低于对照组,差异有统计学意义(P<0.05);观察组抢救成功率高于对照组,差异有统计学意义(P<0.05);观察组满意率高于对照组,差异有统计学意义(P<0.05)。结论儿科急诊分诊中,系统化预检分诊模式的效果显著,值得应用。     

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。     

急诊患者分级分区管理模式对预检分诊质量及准确率的影响

目的探究在急诊科日常工作中采用急诊患者分级分区管理模式对于预检分诊质量及准确率所产生的影响。方法在2018年1月至2020年8月医院收治急诊患者中选取112例作为研究对象,依据随机数字表法将其分为两组,其中,对照组应用常规预检分诊管理模式进行分诊,研究组采用分级分区管理模式进行分诊,对两组患者的分诊质量与准确率进行记录与分析。结果在分诊准确率方面,研究组高于对照组(P<0.05);在分诊质量方面,研究组就诊至处置用时短于对照组(P<0.05);研究组抢救成功率高于对照组(P<0.05);研究组医患纠纷率低于对照组(P<0.05);研究组候诊意外率低于对照组(P<0.05);在患者满意度方面,研究组高于对照组(P<0.05)。结论在急诊科日常工作中,与传统预检分诊模式相比,通过分级分区管理模式的合理应用,有利于实现患者分诊综合质量的提升与改善,对于患者诊疗工作的顺利开展具有积极价值,值得进行应用。     

SBAR 模式在急诊预检分诊中的应用研究

目的 分析在急诊预检分诊中应用 SBAR 模式的临床效果。方法 选择我院 2021 年 7 至 2021 年 12 月期间预检分诊患者 163 例作为对照组，采用传统分类和经验分类的方法。选取我院 2022 年 1 月至 2022 年 5 月急诊预检分诊患者 163 例作为观察 组，实施 SBAR 模式分诊法。比较两组的评估时间、分诊挂号时间、急诊滞留时间、分诊准确率及满意度。结果 观察组分诊 评估、分诊挂号及急诊滞留均短于对照组（P<0.05）。观察组分诊准确率高于对照组（P<0.05）。观察组护理满意度高于对照组 （P<0.05）。结论 应用 SBAR 模型进行急诊预检和分诊，可缩短评估、挂号和等待时间，提高护士预检和分诊的准确性，提 高患者对预检分诊的满意度。     

急诊预检分诊信息系统对急诊预检分诊质量的影响研究

目的探讨急诊预检分诊信息系统对急诊预检分诊质量的影响。方法随机选取本院2017年11月—2018年10月收治的60例急诊患者为研究对象;其中将2018年5月以前收治的30例患者作为对照组,采用传统急诊预检分诊方式对患者进行预检分诊;将2018年5月及以后收治的30例患者作为观察组,采用急诊预检分诊信息系统对患者进行预检分诊。记录并比较两组的分诊评估用时、分诊挂号用时、分诊准确率及危重患者检出率、危重患者等候时间、危重患者候诊意外发生率,设计满意度调查问卷分别对急诊患者或家属满意度及急诊医护人员满意度进行评价并比较。结果观察组的分诊评估用时、分诊挂号用时均较对照组短(P0.05);观察组的危重患者等候时间较对照组短(P0.05);观察组的分诊准确率、危重患者分诊检出率分别为96.67%、100.00%,高于对照组的86.67%、50.00%,候诊意外发生率(0)低于对照组(16.67%),但以上差异均无统计学意义(P0.05);观察组患者或家属对急诊候诊环境、就诊次序、等候时间、预检服务、信息沟通等各项满意度评分均明显高于对照组(P0.05);急诊预检分诊信息系统实施后,急诊医护人员对急诊分诊正确性、候诊有序性、就诊优先性、患者依从性、使用方便性等各项满意度评分均高于实施前,差异有统计学意义(P0.05)。结论采用急诊预检分诊信息系统能够显著提高急诊预检分诊质量,并提高患者的就诊满意度以及医护人员的工作效率和满意度。     

持续护理质量改进模式在门诊预检分诊中的应用效果

目的探讨持续护理质量改进(CQI)模式在门诊预检分诊中的应用效果。方法选取本院门诊部2020年1月至2020年6月接诊的200例患者作为对照组,2020年7月至2020年12月接诊的200例患者作为观察组;每组各配置20名护理人员。对照组给予常规门诊预检分诊,观察组给予CQI模式门诊预检分诊。比较两组的干预效果。结果观察组的分诊评估时间、分诊挂号时间及危重患者等候时间均短于对照组,且分诊准确率高于对照组(P<0.05)。观察组护理人员对患者依从性、候诊有序性、分诊正确性、就诊优先性的满意度评分均高于对照组(P<0.05)。观察组患者对候诊环境、预检服务、等候时间、就诊次序、信息沟通的满意度评分均高于对照组(P<0.05)。结论 CQI模式应用于门诊预检分诊中,可有效缩短患者耗时,提高分诊准确率及护理满意度。     

标准化急诊预检分诊系统的应用及效果评价

目的：探讨急诊预检分诊系统的应用并对其实施效果评价。方法采用简单随机抽样法抽取2013年4~7月在我院急诊就诊的400例患者作为对照组,使用常规急诊预检分诊系统进行分检;抽取2014年4~7月在我院急诊就诊的400例患者作为观察组,使用标准化急诊预检分诊系统进行分诊。比较两组危重患者的等待时间、抢救成功率、意外的发生率、急诊患者的满意度。结果观察组的等候时间明显短于对照组(P<0.05);观察组的意外发生次数、意外发生率小于对照组;观察组在护理服务、候诊环境、信息沟通、就诊次序、急救技能这些方面的得分均高于对照组(均P<0.05)。结论标准化急诊预诊分诊系统的使用能够改善急诊就诊的环境,缓解急诊的拥堵现象,保证急诊就诊患者及时、有效的救治、保证资源的合理有效的分配,值得推广及应用。     

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。     

基于流程分散策略的二次分诊模式在急诊患者候诊管理中的应用

目的:探讨二次分诊模式对急诊患者候诊管理质量的影响。方法:选取2017年11~12月郑州大学第一附属医院急诊科收治的1 350例普通候诊患者为对照组,采用就诊预检分诊模式。选取该院急诊科2018年1~2月收治的1 140例普通候诊患者为观察组,采用二次分诊模式。比较两组患者的候诊质量(候诊不良事件、漏诊率等),调查两组患者的候诊护理满意度。结果:观察组候诊不良事件的发生率、漏诊率低于对照组,差异有统计学意义( P<0.05)。观察组在候诊环境、人文关怀、候诊服务方面的护理满意度高于对照组,差异有统计学意义( P<0.05)。 结论:二次分诊模式能够提高急诊患者的候诊管理质量,减少不良事件的发生,改善护理满意度。     

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。     

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。     

Mental health triage: towards a model for nursing practice

Mental health triage/duty services play a pivotal role in the current framework for mental health service delivery in Victoria and other states of Australia. Australia is not alone in its increasing reliance on mental health triage as a model of psychiatric service provision; at a global level, there appears to be an emerging trend to utilize mental health triage services staffed by nurses as a cost-effective means of providing mental health care to large populations. At present, nurses comprise the greater proportion of the mental health triage workforce in Victoria and, as such, are performing the majority of point-of-entry mental health assessment across the state. Although mental health triage/duty services have been operational for nearly a decade in some regional healthcare sectors of Victoria, there is little local or international research on the topic, and therefore a paucity of established theory to inform and guide mental health triage practice and professional development. The discussion in this paper draws on the findings and recommendations of PhD research into mental health triage nursing in Victoria, to raise discussion on the need to develop theoretical models to inform and guide nursing practice. The paper concludes by presenting a provisional model for mental health triage nursing practice.     

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,     

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.     

改良澳大利亚拣伤评分系统在急诊科拣伤救治中的应用及效果评价

目的评价改良澳大利亚拣伤评分系统在急诊批量创伤患者评估分类中的应用效果。方法按时间先后顺序将178例批量创伤患者分为对照组87例和观察组91例。对照组按照传统方法拣伤分类,观察组应用改良澳大利亚拣伤评分系统评估分类。比较两组拣伤分类时间、分拣准确率、抢救成功率、护士对分类方法满意度和患者/家属对抢救工作满意度。结果观察组评估分类时间低于对照组(P0.01);分拣准确率、抢救成功率(P0.05)、护士对分类方法满意度和患者/家属对抢救工作满意度均高于对照组(P0.01)。结论改良澳大利亚拣伤评分系统能快速准确评估伤情,指导急诊抢救治疗工作,提高抢救效率和成功率,值得在急诊科推广应用。     

Investigating the validity and usability of an interactive computer programme for assessing competence in telephone‐based mental health triage

Telephone‐based mental health triage services are frontline health‐care providers that operate 24/7 to facilitate access to psychiatric assessment and intervention for people requiring assistance with a mental health problem. The mental health triage clinical role is complex, and the populations triage serves are typically high risk; yet to date, no evidence‐based methods have been available to assess clinician competence to practice telephone‐based mental health triage. The present study reports the findings of a study that investigated the validity and usability of the Mental Health Triage Competency Assessment Tool, an evidence‐based, interactive computer programme designed to assist clinicians in developing and assessing competence to practice telephone‐based mental health triage.     

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。     

Paramedic Accuracy Using SALT Triage After a Brief Initial Training

Abstract

Objective. To determine paramedics’ understanding of and accuracy using SALT (sort–assess–lifesaving interventions–treatment/transport) triage, a proposed national guideline for primary triage during mass-casualty incidents, immediately and four months after training. Methods. A 20-minute lecture on SALT triage was provided to all paramedics (n = 320) from a single county during mandatory continuing education. Triage concepts were reemphasized during a 10-minute small-group lecture throughout the study period as part of standard refresher training. After the initial training, all paramedics were asked to complete a posttest consisting of three general knowledge questions about SALT triage and 10 patient scenarios in which they had to assign a triage category. The same test was administered four months after the original educational session. Demographic and job experience information was also obtained. Responses were scored and matched for each paramedic and compared using paired t-test. Results. A total of 290 (91%) paramedics completed the initial posttest. They correctly answered an average (± standard deviation) of 10.7 ± 2.3 of the 13 questions (82%). For the 10 patient scenarios, they correctly triaged an average of 8.1 ± 2.0 patients. A total of 159 paramedics completed both tests. Sixty-seven percent had more than 10 years of emergency medical services (EMS) experience; 72% had prior mass-casualty drill experience; 51% had prior actual mass-casualty experience; and 23% had heard of SALT triage prior to the training. There were no statistically significant differences in initial test scores for any of these demographic groups. For those subjects who completed both tests, the mean overall score for the initial test was 10.9 ± 1.9 (84%) and for the later test was 11.0 ± 1.9 (85%) (p < 0.770; 95% confidence interval [CI] –0.3 to 0.3). For the 10 patient scenarios, the paramedics correctly triaged an average of 8.3 ± 1.7 patients on the initial test and 8.3 ±1.4 patients on the later test (p < 0.565; 95% CI –0.4 to 0.2). Conclusion. Following a short didactic course, paramedics were able to accurately perform SALT triage during a written scenario. Four months after the training, they had retained their understanding of and accuracy using SALT triage. It appears that a brief educational tool was effective for training EMS providers in SALT triage.     

Reliability and Validity of the Emergency Severity Index for Pediatric Triage

Objectives: The Emergency Severity Index (ESI) triage algorithm is a five‐level triage acuity tool used by emergency department (ED) triage nurses to rate patients from Level 1 (most acute) to Level 5 (least acute). ESI has established reliability and validity in an all‐age population, but has not been well studied for pediatric triage. This study assessed the reliability and validity of the ESI for pediatric triage at five sites. Methods: Interrater reliability was measured with weighted kappa for 40 written pediatric case scenarios and 100 actual patient triages at each of five research sites (independently rated by both a triage nurse and a research nurse). Validity was evaluated with a sample of 200 patients per site. The ESI ratings were compared with outcomes, including hospital admission, resource consumption, and ED length of stay. Results: Interrater reliability was 0.77 (95% confidence interval [CI] = 0.76 to 0.78) for the scenarios (n = 155 nurses) and 0.57 (95% CI = 0.52 to 0.62) for actual patients (n = 498 patients). Inconsistencies in triage were noted for the most acute and least acute patients, as well as those less than 1 year of age and those with medical (rather than trauma) chief complaints. For the validity cohort (n = 1,173 patients), outcomes differed by ESI level, including hospital admission, which went from 83% for Level 1 patients to 0% for Level 5 (chi‐square, p < 0.0001). Nurses from dedicated pediatric EDs were 31% less likely to undertriage patients than nurses in general EDs (odds ratio [OR] = 0.31, 95% CI = 0.14 to 0.67). Conclusions: Reliability of the ESI for pediatric triage is moderate. The ESI provides a valid stratification of pediatric patients into five distinct groups. We found several areas in which nurses have difficulty triaging pediatric patients consistently. The study results are being used to develop pediatric‐specific ESI educational materials to strengthen reliability and validity for pediatric triage.