急危重症患者标准化院内分级转运体系的实施与效果
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摘要
目的:在急危重症患者中实施标准化院内分级转运体系,以改善医疗服务质量。方法:规范化实施急危重症患者院内分级转运标准和流程,并将急危重症患者分级转运评估表应用于转运中;同时,建立健全质量控制制度与标准,进行持续质量改进,并在全国范围内开展教育培训以实现分级转运标准和流程的专业化、统一化。结果:急危重症患者院内分级转运体系实施后,Ⅰ级、Ⅱ级、Ⅲ级转运平均耗时均缩短,转运不良事件发生率由7.49%降低至1.40%,患者家属和接收科室满意度提升,差异均具有统计学意义(P<0.05)。结论:急危重症患者院内分级转运体系的实施降低了转运风险,保障了患者安全,改善了医疗护理服务质量,充分诠释了优质护理服务工作的内涵。
Objective: To apply a standardized classification and transportation system to critically ill patients in hospital to improve the quality of medical services. Methods: Criteria and procedures of the classification and transportation system for critically ill patients in hospital were established and standardized, and the Transportation Assessment Form for Critical Patients was used through the transportation process. Meanwhile, a sound and complete quality control system and standards were formulated to make room for continuous improvement. Besides, education and training were offered all around the country to ensure that effective transportation could be carried out both professionally and normally. Results: After the implementation of the classification and transportation system for critically ill patients in hospital, the average time spent on Class Ⅰ, Ⅱ, and Ⅲ transportation was significantly reduced, and the incidence of adverse events observed during patient transportation decreased from 7.49% to 1.40%. The satisfaction degree of both family members and receiving departments was significantly improved(P<0.05). Conclusion: The classification and transportation system for critically ill patients in hospital has reduced the risk of transportation, ensured patients' safety, and fully demonstrated the meaning and continuous improvement of nursing service.
Objective: To apply a standardized classification and transportation system to critically ill patients in hospital to improve the quality of medical services. Methods: Criteria and procedures of the classification and transportation system for critically ill patients in hospital were established and standardized, and the Transportation Assessment Form for Critical Patients was used through the transportation process. Meanwhile, a sound and complete quality control system and standards were formulated to make room for continuous improvement. Besides, education and training were offered all around the country to ensure that effective transportation could be carried out both professionally and normally. Results: After the implementation of the classification and transportation system for critically ill patients in hospital, the average time spent on Class Ⅰ, Ⅱ, and Ⅲ transportation was significantly reduced, and the incidence of adverse events observed during patient transportation decreased from 7.49% to 1.40%. The satisfaction degree of both family members and receiving departments was significantly improved(P<0.05). Conclusion: The classification and transportation system for critically ill patients in hospital has reduced the risk of transportation, ensured patients' safety, and fully demonstrated the meaning and continuous improvement of nursing service.
引文
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[14]李佩涛,张会芝,崔现杰,等.医护一体化管理模式在ICU患者安全转出中的应用.中国护理管理,2018,18(1):90-93.Liu PT,Zhang HZ,Cui XJ,et al.Medical integration mode in handoffs for patient transitioning from the Intensive Care Unit.Chinese Nursing Management,2018,18(1):90-93.
[15]李芬,朱佳晖,邓先锋,等.专业化转运团队在院内急重症患者转运中的作用.护理学杂志,2016(11):78-80.Li F,Zhu JH,Deng XF,et al.The role of trained and specialized team in intra-hospital transport of critically ill patients.Journal of Nursing Science,2016(11):78-80.
[16]蔡艳芳,郭履平,李文娟.转运流程在重症病人院内转运中的应用.现代临床护理,2014(6):80-83.Cai YF,Guo LP,Li WJ.Application of transport procedure on intra-hospital transport of critically ill patients.Modern Clinical Nursing,2014(6):80-83.
[17]魏雪莉,缪锐钰,马丽,等.三级预警系统管理方案在院内转运危重症患者中的应用研究.护士进修杂志,2017(22):2047-2049.Wei XL,Miu RY,Ma L,et al.Research on the application of the three-level early warning system management scheme in hospital transportation of critically ill patients.Journal of Nurses Training,2017(22):2047-2049.
[18]许晓萍,陈毅文,陈艺延.急危重症患者院内安全转运路径的建立与实施.护理学杂志,2012(7):11-14.Xu XP,Chen YW,Chen YY.Intra-hospital transfer of critically ill patients:establishment and implementation of transfer pathway.Journal of Nursing Science,2012(7):11-14.
[2]Venkategowda PM,Rao SM,Mutkule DP,et a1.Unexpected events occurring during the intra-hospital transport of critically ill ICUpatients.Indian J Crit Care Med,2014,18(6):354-357.
[3]赵伟英,Greaney Brendan,陈三妹,等.危重患者安全转运的研究现状和展望.中华急诊医学杂志,2013,22(2):219-221.Zhao WY,Greaney B,Chen SM,et a1.Present situation and prospect of safe transshipment of critically ill patients.Chinese Journal of Emergency Medicine,2013,22(2):219-221.
[4]Gillman L,Leslie G,Willianls T,et a1.Adverse events experienced while transferring the critically ill patient from the emergency department to the intensive vale unit.Emerg Med J,2006,23(11):858-861.
[5]Papson J P,Russell K L,Taylor DM.Unexpected events during the intrahospital transport of critically ill patients.Acad Emerg Med,2007,14(6):574-547.
[6]史冬雷,张红梅,高健,等.分级转运模式在急诊危重症患者院内转运中实施的效果评价.中国护理管理,2016,16(5):639-642.Shi DL,Zhang HM,Gao J,et al.Application of hierarchical transport mode in the intra-hospital transport of critically ill patients in emergency department.Chinese Nursing Management,2016,16(5):639-642.
[7]急诊危重症患者院内转运共识专家组.急诊危重症患者院内转运共识--标准化分级转运方案.中国急救医学,2017(6):481-485.Consensus Expert Group on Hospital Transshipment in Emergency Critical Patients.Consensus on hospital transport in emergency critical patients.Chinese Journal of Emergency Medicine,2017(6):481-485.
[8]高健,刘晓颖,史冬雷.《急诊危重症患者院内转运共识》解读--标准化分级转运方案的实施.中国急救医学,2017(6):485-487.Gao J,Liu XY,Shi DL.Interpretation of the Consensus on Hospital Transshipment in Emergency Critical Patients:implementation of the standardized classification transshipment scheme.Chinese Journal of Critical Care Medicine,2017(6):485-487.
[9]刘学英,黄丽华,邹翼霜,等.转运核查单的编制及在院内危重患者转运中的应用.中华护理杂志,2016,51(12):1469-1473.Liu XY,Huang LH,Zou YS,et al.The impact of intra-hospital transport checklist on transport safety of critically ill patients.Chinese Journal of Nursing,2016,51(12):1469-1473.
[10]刘学英,黄丽华.危重患者院内转运核查单的研究进展.护理与康复,2017(2):134-137.Liu XY,Huang LH.Research progress on inpatient transit verification form for critical patients.Nursing and Rehabilitation Journal,2017(2):134-137.
[11]刘华晔,曹艳佩,杨晓莉.急诊患者院内转运流程的持续改进.护理学杂志,2017,32(12):5-7,16.Liu HY,Cao YP,Yang XL.A quality improvement program of intrahospital transport of critically ill patients from emergency department.Journal of Nursing Science,2017,32(12):5-7,16.
[12]中华医学会重症医学分会.《中国重症患者转运指南(2010)》(草案).中国危重病急救医学,2010,22(6):328-330.Society of Critical Care Medicine,Chinese Medical Association.Chinese guidelines for the transport of critically ill patients,2010.Chinese Critical Care Medicine,2010,22(6):328-330.
[13]万林,施素华,孔悦,等.危重患者院内转运的研究进展.中华护理杂志,2016,51(8):975-978.Wan L,Shi SH,Kong Y,et al.Research progress on hospital transshipment of critical patients.Chinese Journal of Nursing,2016,51(8):975-978.
[14]李佩涛,张会芝,崔现杰,等.医护一体化管理模式在ICU患者安全转出中的应用.中国护理管理,2018,18(1):90-93.Liu PT,Zhang HZ,Cui XJ,et al.Medical integration mode in handoffs for patient transitioning from the Intensive Care Unit.Chinese Nursing Management,2018,18(1):90-93.
[15]李芬,朱佳晖,邓先锋,等.专业化转运团队在院内急重症患者转运中的作用.护理学杂志,2016(11):78-80.Li F,Zhu JH,Deng XF,et al.The role of trained and specialized team in intra-hospital transport of critically ill patients.Journal of Nursing Science,2016(11):78-80.
[16]蔡艳芳,郭履平,李文娟.转运流程在重症病人院内转运中的应用.现代临床护理,2014(6):80-83.Cai YF,Guo LP,Li WJ.Application of transport procedure on intra-hospital transport of critically ill patients.Modern Clinical Nursing,2014(6):80-83.
[17]魏雪莉,缪锐钰,马丽,等.三级预警系统管理方案在院内转运危重症患者中的应用研究.护士进修杂志,2017(22):2047-2049.Wei XL,Miu RY,Ma L,et al.Research on the application of the three-level early warning system management scheme in hospital transportation of critically ill patients.Journal of Nurses Training,2017(22):2047-2049.
[18]许晓萍,陈毅文,陈艺延.急危重症患者院内安全转运路径的建立与实施.护理学杂志,2012(7):11-14.Xu XP,Chen YW,Chen YY.Intra-hospital transfer of critically ill patients:establishment and implementation of transfer pathway.Journal of Nursing Science,2012(7):11-14.