深圳市2002年急诊住院死亡病例调查

Investigation into the deaths of emergency hospitalization cases in Shenzhen in 2002

目的 查找急救各环节存在的问题 ,降低急救死亡率和伤残率 ,为进一步建设和完善急救网络提供客观依据。方法 对照 2 0 0 2年全市 6 0个急救网络医院急诊入院急救的 14 4 6份死亡病历填写调查表 ,用Profox6 0建立数据库 ,用SPSS 11 0统计分析。结果 各项急救处置用时中位数 :下达首次医嘱、执行首次医嘱和上级医师到场均为 5min ,二线医师到场 10min ;病情讨论和院内会诊时间分别为入院后 12 0min和 180min ;开始输血时间为入院后 6 0min。调查中发现一些医师对急救技术和程序掌握不到位 ,医疗文书时间因素记录不详细 ,存在制度不落实的现象 ;急诊住院死亡和院前死亡的死因谱有差别。结论 急诊住院急救在时间因素、技术因素和质量因素等方面需进一步提高 。

Objective To identify problems and reduce death and disability rates in emergency care so as to provide basis for upgrading the emergency care network. Methods Questionnaires were filled out with information from the medical records of 1446 cases that had been admitted for emergency care to 60 hospitals of the city's emergency care network and that had died in 2002, a database was set up with Profox 6 0, and a statistical analysis was made with SPSS 11 0. Results The median time for various emergency care procedures was: 5 minutes for the issuing and execution of the first medical order respectively and also for the arrival of a senior doctor; 10 minutes for the arrival of the doctor on call; 120 and 180 minutes after admission respectively for case discussion and intra-hospital consultation; 60 minutes after admission for the start of blood transfusion. It was found that some doctors had a poor grasp of emergency care techniques and procedures, the entry of time was not detailed enough in some medical documents, and some rules and regulations failed to be carried out. In addition, differences existed in the spectrum of causes of post-emergency hospitalization death and pre-hospitalization death. Conelusion Improvements need to be made in such aspects of emergency hospitalization care as the detailing of time, the grasp of techniques and the guarantee of quality. And more attention needs to be attached to emergency care.