院内急救快速反应系统的改进与应用

目的 改进院内急救快速反应系统,构建院内急救“3P”管理模式,并对其应用效果进行评价,为改善院内急救护理管理质量提供参考。 方法 通过查阅文献、急救管理专家组讨论和2轮德尔菲专家函询,确立院内急救“3P”管理模式指标,并于2017年4月—2018年3月应用于临床。结果 2轮函询问卷的有效回收率均为100%,第2轮函询专家的权威系数为0.907,判断依据系数为0.947,熟悉程度系数为0.867,一、二、三级指标重要性的肯德尔和谐系数分别为0.233、0.128和0.272,一、二、三级指标可操作性的肯德尔系数分别为0.211、0.135和0.277,显著性检验均有统计学意义（P<0.05）,最终形成的院内急救“3P”管理模式包含3个一级指标（1P急救技能再培训、2P急救流程再优化、3P急救物资再配置）、13个二级指标和34个三级指标。临床应用后,护士综合急救技能实践考核成绩由应用前的（69.07±4.80）分提高到（85.40±2.68）分;非预期性院内心搏骤停患者急救时启动应急医疗服务系统时间由应用前的（6.12±1.85） min缩短至（1.26±0.60） min,开始心肺复苏时间由应用前的（2.72±1.35） min缩短至（0.78±0.06） min,开始除颤时间由应用前的（8.51±3.12） min缩短至（1.43±0.94） min,急救成功率由应用前的55.56%提高到83.79%,差异均具有统计学意义（P<0.05）。结论 院内急救“3P”管理模式具有较好的可靠性、科学性和实用性,可为医院改善院内急救护理质量提供参考。

The improvement and application of a rapid response system of in-hospital first aid

Objective To build a “3P” management model of in-hospital first aid and to evaluate the effects of its application,which provides references for improving the quality of emergency care management. Methods Through literature review,emergency management expert group discussion and 2 rounds of Delphi expert consultations,the “3P” management model index system was established and applied in the clinic from April 2017 to March 2018. Results The effective recovery rates of the 2 rounds of the questionnaire were both 100%. The authority coefficients of the experts in the second round of the questionnaire was 0.907;the judgment basis coefficient was 0.947;the familiarity coefficient was 0.867. The Kendall harmony coefficients of the importance of the first,second and third level indicators were 0.233,0.128 and 0.272,respectively. The Kendall coefficients of the operability of the first,second and third level indicators were 0.211,0.135 and 0.277;the differences were statistically significant（P<0.05）;the final "3P" management model includes 3 first-class indicators（1P：first-aid skills retraining,2P：first-aid process re-optimization,3P：first-aid materials re-allocation）,13 second-class indicators and 34 third-class indicators. After clinical application,the score of nurses’ comprehensive first-aid skills practice assessment increased from（69.07±4.80） to（85.40±2.68）;the EMSS start-up time of unexpected IHCA patients was shortened from（6.12±1.85） min to（1.26±0.60） min;the CPR start-up time was shortened from （2.72±1.35） min to （0.78±0.06） min;the defibrillation start-up time was shortened from （8.51±3.12） min to（1.43±0.94） min;the first-aid success rate of unexpected CA patients in hospital increased from 55.56% to 83.79%. The differences were statistically significant（P<0.05）. Conclusion The "3P" mode of in-hospital first aid has good reliability,scientificity and practicablity,which can provide references for improving the quality of emergency care.