上海急诊医患分诊认知调查

当今急诊医疗服务需求的扩展已超越了急诊室有限的空间与资源,急诊预检分诊是对急诊患者进行快速分类以确定治疗或进一步处理优先次序的过程.分诊可以判断哪些患者需要立即救治,从而保证患者安全;同时又要防止分检不足或过度分检,以避免急诊资源的提前耗尽.     

危重病病情评价系统在急诊分诊中的应用现状

急诊分诊可以判断哪些患者需要立即被救治,以保证患者安全;同时,分诊时还要防止分检不足或过度分检,以避免急诊资源的浪费。在美国、加拿大、澳大利亚、日本、欧洲及中国香港等地区,急诊科都有完善的分诊制度与分诊标准[1]。目前,我国内地尚缺乏统一的急诊预检分诊标准,大多数医院的     

影响急诊预检有效性的因素与对策

急诊室是体现一个医院综合水平的窗口,急诊护理工作是医院整体护理质量的重要体现。而预检分诊作为急诊患者就诊的第一道关口,其工作质量直接关系到急诊服务质量,患者的救治效果和对医院的满意度。预检是根据病情的严重程度决定提供医疗服务的优先顺序,目的是为了确保患者能够根据其病情的紧急程度得到及时和适当的治疗。近年来,急诊医疗服务需求大大超出了急诊室有限的空间和资源,急诊室拥挤现象已逐渐被世界各国政府和医疗界所重视。而预检可以判断哪些患者需要立即救治,     

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。     

再评估在急诊预检分诊中的研究进展

总结了再评估的概念及在急诊预检分诊中的研究进展,主要包括再评估在国内外的发展及应用、在儿科急诊预检分诊中的作用,认为研究再评估在急诊预检分诊中的进展,可为制定相关护理流程提供参考,进而保障真正的急诊患者得到及时的救治。     

国内急诊预检分诊标准制定及现状

正急诊预检是指在患者到达急诊科时予以快速分类的过程[1]。医院急诊是急诊医疗服务中最重要而又最复杂的中心环节,是医院的窗口,也是医疗活动的第一线,承担24 h各类伤病员的紧急救治任务。近几年,随着急诊医学的发展,在全世界急诊拥挤现象日趋严重,预检分诊工作已逐渐成为急救医学的重要环节[2]。国外急诊预检均采用病情分级的方式来决定患者就诊的优先权。我国虽然了解急诊预检分诊工作的重要性,但由于人口众多、医疗体制不健全,医疗资源分配     

改良预警评分在小儿急诊预检分诊救治中的应用观察

目的探讨改良预警评分(MEWS)在小儿急诊预检分诊救治中的应用效果。方法选取2017年6月～2019年6月我院急诊救治的患儿140例,采用随机数字表法分为对照组和观察组各70例。对照组给予常规急诊预检分诊处理,观察组在此基础上进行MEWS急诊预检分诊救治,对比分析两组分诊后的分诊准确率及家属护理满意度。结果分诊结束后,观察组分诊准确率为98.57%显著高于对照组的85.71%,差异有统计学意义(P<0.05);观察组家属满意度为98.57%,显著高于对照组的84.29%,差异有统计学意义(P<0.05)。结论将MEWS评分应用于小儿急诊预检分诊救治中,可提高对小儿重症患者的分诊准确率,增强患儿家属满意度。     

加拿大急诊预检程序

预检分诊作为急诊工作的第一关,关系到整个急诊工作的医疗护理质量。急诊预检的目的是护士针对患者不同的病情和可能的病因,向其指明合适的治疗场所并根据病情的轻重缓急确定就诊的先后次序,同时对于危重患者使用绿色通道,缩短等待时间,提高急诊救治率。加拿大的急诊预检程序采用的是目前先进的国际预检标尺,该项预检标尺是1993年     

急诊不同预检分诊级别患者就诊规律分析

目的:了解某院急诊就诊患者预检分诊情况,为急诊科的医疗、管理和服务提供参考依据。方法:对2016年6月1日至2017年2月31日,来该院就诊的104536例急诊患者,其预检分诊数据来自医院的信息系统,对预检患者就诊日期和时间、就诊科室和预检分诊等级等资料进行描述性分析。结果:Ⅰ、Ⅱ、Ⅲ、Ⅳ级就诊患者所占的比重分别为0.22%、3.35%、53.74%、42.69%;急诊内科、急诊儿科和急诊外科分别占就诊患者人数的34.98%,20.01%和18.13%;急诊患者就诊时间有一定的规律性,16时至20时就诊人数快速增加,20时达到就诊高峰;夏秋季急诊就诊患者较为集中。结论:急诊预检分诊具有特定的时间规律,应按照急诊就诊患者的相关情况,适当优化急诊医疗资源。     

分区分级管理模式在急诊科中的临床实践效果分析

目的:为了使危重患者得到及时的救治,切实提高急诊科的服务能力,根据卫生部对急诊科的要求,急诊科分区分级模式及流程重新进行设计,使之符合卫生部的要求,满足急诊患者的需求。方法:2013年2月起对急诊患者进行分级分区管理,按照病情分级标准进行预检分诊,并根据患者病情进行分区域救治。结果:实施急诊患者分级分区管理模式后,急诊科在布局和功能上均得到了改进,使危急患者迅速得到了抢救,患者在不同区域得到充分有效的护理,满足了急诊患者的就医需求,改善了急诊室患者候诊时间过长,轻重患者混合排队就诊,降低了重症患者救治时间延误的可能性,提高了抢救成功率。结论:急诊实施分级分区管理可使急重症患者在医院及时得到快速救治,减少和减轻病情延误和疾病伤害,改善患者的预后,同时以有限的急救医疗资源取得优质的医疗服务结果,可提高医疗护理安全,有效地降低护理风险。     

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。     

4级分级标准在急诊分诊工作中的应用研究

目的 探讨《医院急诊科规范化流程》(4级分级标准)在急诊分诊中的应用效果。方法 选取2016年6月1日-2016年7月1日于本院急诊科就诊的1 252例患者按4级分级标准进行分诊评估,以改良早期预警评分(modified early warning score,MEWS)分级标准作为对照,比较2种标准的分诊结果、分诊时间。结果 4级分级标准与MEWS标准的分诊时间分别为(3.1±0.5)min、(3.9±0.7)min,2者比较差异有统计学意义(t=6.341,P=0.018)。2种标准分诊结果比较,差异无统计学意义(Z=-0.220,P=0.826)。结论 《医院急诊科规范化流程》推荐的4级分级标准安全可靠,且分诊时间短于MEWS标准,适合在我国急诊就诊量快速增长的急诊部门推广应用。     

Special considerations for pediatric triage in the emergency department

Pediatric emergencies are a common problem resulting in approximately 12.5 million visits to the emergency department yearly. The triage of ill or injured children involves the same processes as that of an adult. The needs of children in emergency situations however, are different and require special attention. Developmental and physiologic variations make communication, assessment, and the identification of serious illnesses or injury quite different when compared with adult triage. Practice and ongoing education concerning pediatric triage should allow emergency department nurses to develop a sixth sense in recognizing and treating children and to become confident in triage decisions.     

Validation of physiological scoring systems in the accident and emergency department

Background

Scoring systems that weigh the degree of abnormality of bedside observations might be able to identify patients at risk of catastrophic deterioration.

Objectives

To establish a frequency distribution for typical physiological scoring systems and to establish the potential benefit of adding these to an existing triage system in accident and emergency departments.

Methods

Physiological data were collected from 53 unselected emergency department admissions, from 50 patients admitted from the emergency department to intensive care, and from 50 patients admitted from emergency department to general wards and then to intensive care. Three different physiological scores were calculated from the data. Identification of sick patients by the scores was compared with triage information from the Manchester Triage System (MTS).

Results

Most patients admitted to the emergency department would not be identified as critically ill with the aid of physiological scoring systems. This was true even for patients who were admitted to intensive care. Only in 0–8% of unselected patients did the scores indicate increased risk. In 100 patients admitted to the intensive care, adding of medical emergency team call‐out criteria, Modified Early Warning Score or Assessment Score for Sick patient Identification and Step‐up in Treatment would identify none, seven or one patient in addition to those triaged as orange and red by the MTS.

Conclusions

Introduction of a physiological scoring system would have identified only a small number of additional patients as critically ill and added little to the triage system currently in use.Delayed recognition of critically ill patients increases the risk of cardiopulmonary arrests¹ and death in the intensive care unit (ICU).² Usage of algorithms based on bedside observations might improve recognition and outcome of patients on hospital wards.³The overall prognosis of patients admitted to ICU directly from emergency departments is better than the prognosis for those admitted to the ICU from general wards.⁴ Most emergency departments use triage systems to identify those patients requiring the most urgent attention. The Manchester Triage system (MTS) is one of the most commonly used triage systems in the UK and triages patients across a large variety of medical and surgical specialties. The MTS uses protocols based on the presenting complaint and questions about potentially aggravating factors. It is designed as a tool for prioritising the urgency of being seen, but its ability to assess the severity of the disease has been questioned.⁵It is not known whether a system based on physiological parameters would be able to identify patients at risk of intensive care admissions better than the MTS or provide additional information about the severity of the condition of a patient in the setting of an emergency department. A pilot study conducted in the Wrexham Maelor Hospital, Wrexham, UK, has examined Modified Early Warning Scores (MEWS) in patients admitted to the emergency department and classified as orange according to the MTS. The study suggested that patients with high scores had a higher likelihood of being admitted to hospital than those with low MEWS.⁶ Medical and elderly patients had higher MEWS than younger and surgical patients. In the setting of the emergency department, a serial evaluation of physiological scores might be better for detecting critical illness than a single assessment.⁷Accuracy of triage by using the Manchester Triage System has not been compared with the accuracy of a severity classification based on physiological parameters.It is not known whether a physiologically based triage system could potentially shorten the time of transfer from the emergency department admission to ICU and avoid inappropriate admissions of critically ill patients from the emergency department to the general wards.     

An ABC approach to assessing the risk of violence at triage

There is evidence to suggest that the incidence of violent behaviour in the emergency department by patients toward staff is on the rise. As part of the process of determining urgency, triage nurses must assess the risk of violence at point of entry. The risk of violence, that is, behaviour that either involves a threat of physical or psychological harm to one's self or to others, is considered a critical predictor of urgency in mental health triage. A rapid violence risk assessment strategy will be described which can be utilised in emergency department triage.     

标准化急诊预检系统的使用效果

目的采用标准化急诊预检系统对急诊预检进行干预并观察其效果。方法采用便利抽样法抽取2008年7-9月某院急诊就诊的300例患者作为对照组,采用常规预检系统进行预检;同法抽取2009年7-9月某院急诊就诊的300例患者作为实验组,采用标准化预检系统进行预检。以自行设计的满意度调查表对两组急诊患者进行开放式问卷调查,对其基本资料、需求内容以及满意度进行相关分析。结果实验组危重患者就诊等待时间缩短、抢救成功率提高,与对照组比较,差异有统计学意义（P〈0.01或P〈0.05）;对照组有2例患者在候诊期间发生意外事件,而实验组无一例患者在候诊期间发生意外事件。实验组患者满意度较高,与对照组比较,差异有统计学意义（均P〈0.05）。结论采用标准化的急诊预检系统进行预检使危重患者等待救治时间缩短,候诊期间意外事件发生率显著下降,明显提高了危重患者抢救成功率及急诊患者满意度。该系统可在综合医院急诊科推广应用。     

Effectiveness of a 6-week online course in the Canadian Triage and Acuity Scale for emergency nurses.

INTRODUCTION: There is increasing interest in 5-level triage systems in emergency departments; however, the adoption of a new system places heavy training demands on ED department nurses and physicians. One emerging training option is online learning. The purpose of this study was to explore the effectiveness of an online course in the 5-level Canadian Triage and Acuity Scale (CTAS) on the clinical practice of the triage nurse. METHODS: Interviews were held with 23 emergency nurses from across Canada. A chart audit of triage codes from 367 charts from 6 hospitals was conducted. RESULTS: The most consistent finding was that the majority of RN staff enjoyed the online course and believed it had improved their triage practice. Nurses believed that their patient assessments were more thorough, accurate, and consistent throughout the department. Improved communication between staff and with patients and families was identified. Nurses reported using what they learned to improve triage assessment. Triage accuracy was high; the overall agreement between CTAS graduates and the chart auditor/expert within one CTAS level was 99.7%. Nurses also identified a number of organizational barriers to CTAS implementation after the course. DISCUSSION: The online format appears to be an effective, efficient, and convenient way to educate large numbers of ED staff in CTAS. Further research is needed regarding the use of multimedia and computer online chat options to further enhance the online learning experience for nurses.