改良早期预警评分系统在急诊危重患者院内转运中的应用

目的研究改良早期预警评分系统(modified early warning score,MEWS)在急诊危重患者院内转运中的应用效果。方法回顾性分析2013年6月至2015年5月在昆山市第一人民医院急诊科就诊的957例Ⅰ级危重患者。其中2013年6月至2014年5月就诊的458例患者作为对照组,采用常规转运方式,即由一名急诊专科护士负责转运;2014年6月至2015年5月就诊的499例患者作为研究组,应用MEWS对患者进行转运前评分、合理安排转运人员及设备。比较两组患者在转运过程中不良事件的发生率、处置成功率及转运护士的心理压力情况。结果研究组不良事件的发生率低于对照组(8.0%vs.27.9%),转运过程中心搏骤停、呼吸困难及窒息、管道脱落(移位)或堵塞等不良事件的处置成功率均高于对照组,差异均有统计学意义(P0.05或P0.01);采用MEWS后,护士转运时心理压力明显减轻,差异有统计学意义(P0.01)。结论应用MEWS对急诊危重患者进行转运前的风险评估,并以此为依据来指导患者转运、规范转运流程,不仅有助于提高转运安全性、减少不良事件的发生率,还能减轻护士的心理压力,值得临床进一步推广应用。

Application of Modified Early Warning Score on In-hospital Transfer of Emergency Critically Ill Patients

Objective To study the application effect of modified early warning score (MEWS)on in-hospital transfer of emergency critically ill patients.Methods Clinical data of 9 5 7 cases was analyzed retro-spectively.The 456 cases admitted from June 2013 to May 2014 were selected as control group,and received routine hospital transfer method as one nurse from emergency department took charge of the transfer. Other 499 cases admitted from June 2014 to May 2015 were selected as study group,and applied with MEWS to evaluate before transfer,and reasonably arrange equipments and personnel.The incidence rate of adverse events during transfer,success handling rate and psychological stress of nurses were compared between two groups.Results The incidence rate of adverse events in study group was lower than control group (8.0% vs.27.9%),the success handling rates of cardiac arrest,expiratory dyspnea and asphyxia, cannula fall (displacement)and blockage in study group were higher than control group (P<0.05 or P<0.01).Nurses’psychological stress was significantly reduced after the application of MEWS (P<0.01). Conclusions The application of MEWS to evaluate the risk,guide the patients transfer accordingly,and standardise the transfer process,which can help to increase the safety,reduce the incidence rate of adverse events,and also reduces nurses’psychological stress.It is worth for further application in clinic.