流程管理与患者分层对提高急诊冠脉介入术护理质量的效果

The effect of process management and patient stratification on improving the quality of care in emergency coronary intervention

目的 探讨流程管理与患者分层对提高急诊冠脉介入术护理质量的效果.方法 运用流程管理理论对急诊冠脉介入手术（PCI）患者护理服务中可能存在的问题进行调查分析并加以改进,在急诊PCI已有的工作流程基础上制订出更加科学、规范的管理程序,并引导护理人员根据PCI患者病情进行分层次管理,统计分析流程管理实施前后1年PCI患者护理质量评分、抢救成功率、护理人员接诊时间、手术等候时间、手术时间、医患矛盾发生率、护理风险事件发生率、患者满意率及护理人员满意率.结果 实施后PCI患者急诊基础护理、特级护理、急诊秩序管理、文书管理、重点环节管理、急救药品管理及总护理质量评分分别为（30.96±4.23）分、（18.45±4.02）分、（19.98±4.11）分、（19.08±4.78）分、（15.96±4.25）分、（11.08±2.85）分和（112.45±24.15）分,显著高于实施前的（20.12±3.78）分、（12.98±3.12）分、（12.38±3.69）分、（11.36±4.25）分、（10.45±3.86）分、（7.12±1.52）分和（75.12±15.23）分,差异有统计学意义（P＜0.05）.实施后护理人员接诊时间、PCI等候时间、手术时间分别为（10.12±2.78）min、（12.45±2.89）min和（30.25±3.02）min,显著低于实施前的（15.25±3.12）min、（22.25±3.89）min和（35.12±3.58）min,差异有统计学意义（P＜0.05）.实施后医患矛盾发生率、护理风险事件发生率分别为33.33％和1.67％,低于实施前的17.24％和13.79％,差异有统计学意义（P＜0.05）;而患者抢救成功率、满意率及护理人员满意率分别为100.00％、100.00％和96.67％,高于实施前的91.38％、72.41％和65.52％,差异有统计学意义（P＜0.05）.结论 流程管理与患者分层能有效改善急诊PCI患者护理质量,优化护理服务,提高患者满意度.

Objective To investigate the effect of process management and patient stratification to improve the quality of care in emergency coronary intervention.Methods The care problems of emergency surgery coronary intervention（PCI） were improved with process management theory.The more scientific,standardized management procedures,and guide management of nursing staff of emergency PCI on the basis of the existing workflow were developed.The condition of patients before and after of the PCI were analyzed.The PCI patient care quality score,rescued rate,nurses admissions time,surgery waiting time,operation time,the incidence of doctor-patient conflicts,care risk event rate,patient satisfaction and nursing staff satisfaction before and after the implementation were analyzed.Results The patients with basic care（30.96±4.23）,intensive care（18.45±4.02）,emergency order management（19.98±4.11）,document management（19.08±4.78）,focusing on aspects of management（15.96±4.25）,emergency medicine management （11.08±2.85） and overall quality of care score（112.45±24.15） after the implementation of emergency after PCI were higher than before the implementation （20.12±3.78）,（12.98±3.12）,（12.38±3.69）,（11.36±4.25）,（10.45 ±3.86）,（7.12± 1.52）,（75.12± 15.23） （P〈0.05）.The nursing admissions time （10.12±2.78）,PCI waiting time （12.45±2.89）,operative time （30.25±3.02） after the implementation of nursing were lower than before the implementation （15.25±3.12）,（22.25±3.89）,（35.12±3.58） （P〈0.05）.The incidence of doctor-patient conflicts（33.33%）,nursing event rate （1.67%） after the implementation of nursing were lower than the before implementation 17.24%,13.79%（P〈0.05）,while the survival rate of patients （100.00%）,satisfaction （100.00%） and nursing staff satisfaction （96.67%） were higher than before the implementation 91.38%,72.41%,65.52%（P〈0.05）.Conclusion Process management and patient stratification can improve the quality of care in emergency PCI patients,optimize care,improve patient satisfaction.