儿科急诊潜在危重病的早期识别与管理

The early recognition and management mode of potential critical diseases in pediatric emergency department

目的 :实施儿科急诊潜在危重病患儿的临床处理流程及管理方法,早发现、早识别、早治疗潜在危重病患儿,从而降低患儿死亡率,减少医疗纠纷。方法 :建立儿科急诊预检分诊识别流程;制定早期筛选儿科急诊潜在危重病的临床方案。结果:2010-2013年,我院实施儿科急诊潜在危重病的早期识别与管理后,早期发现了爆发性心肌炎10例、肠道病毒71型(EV71)感染重症病例9例、脓毒症8例、流行性脑脊髓膜炎2例,阻止医疗纠纷10例,发生医疗纠纷仅7起,较2006-2009年(实施前)发生的医疗纠纷减少8起,死亡人数由163例下降到118例。结论 :建立规范的儿科急诊潜在危重病患儿的临床识别流程及管理方法,能提高急诊医护人员早期识别儿科急诊潜在危重病的能力,降低患儿死亡率,减少医疗纠纷。

Objective： To establish a clinical process flow and management mode of potential critical diseases in pediatric emergency department, in order to recognize and treat patients early to reduce mortality and avoid medical conflicts. Method： The recognition process of pediatric emergency triage was established; clinical scheme for early screening of potential critical disease in pediatric emergency department was enacted. Result： From 2010 to 2013, after application of clinical recognition process and management mode, 10 cases of fulminant myocarditis, 9 cases of EV71-associated severe infection; 8 cases of pyemia and 2 cases of epidemic cerebrospinal meningitis were early recognized, which helped avoid 10 cases of medical conflicts. There were totally 7 cases of medical conflicts only, which were 8 cases less compared to the cases reported between 2006 and 2009.The death toll decreased to 118 from 163 before the intervention. Conclusion： The establishment of standard clinical process flow and management mode can increase the early recognition ability of medical staff in emergency department, which can obviously decrease mortality and medical conflicts.