区域性危重患者院际转运风险管理探讨

The risk management of regional inter-hospital transportation of critical ill patients

目的 探讨进一步提高区域性危重症患者院际转诊的转运水平.方法 回顾性分析2008年6月至2013年5月749例院际转诊患者的临床资料,分别按院际转诊患者的年龄、里程数、院前急救的病种、是否需要特殊医疗器械及出车记录和转归等进行统计,对所得的数据进行统计学描述.结果 院际转诊患者中男472例（63.0％）,女277例（37.0％）,年龄18-60岁.转诊数各月份基本相似,病种以颅脑损伤为主,其中240例需机械通气支持;转诊距离最远长达1790公里.730例患者安全转送回医院,10例途中要求停止转运,死亡9例,未出现投诉.结论 院际转诊是一项新的院前急救技术,建立中西部的区域性危重症患者转运网络,形成以郑州市紧急医疗中心为平台,我院自主型急救中心为中心向周围辐射,集转运、通信联络和培训为一整体的特殊医疗系统,加入该转运网络的沿途城市急救中心都是可信赖的求助对象;院外院内绿色通道一站式服务是保证危重患者院际远程转诊安全成功的有效措施.但需对整个转诊过程的所有环节可能存在的风险进行预防与处理.

Objective To improve the level of regional inter-hospital transportation of critical ill patients.Methods According to age,mileage,disease of pre-hospital emergency,demand of special medical equipment（such as breathing machines,etc） and trip logs and outcomes,and so on,a total of 749 inter-hospital transportation of critical ill patients,clinical data（June 2008 to May 2013） was conducted to investigate and describe by statistics.Results Inter-hospital transportation 472 cases of male patients,accounting for 63.0%,female 277 cases,accounting for 37.0% ; ages rang from 18 to 60 years old ; basically similar to the number of visits each month,mainly to traumatic brain injury,where 240 patients requiring mechanical ventilator support; visits distances up to 1790 km.The 730 severe patients were transported to hospital safely,on the way to stop forwarding 10 cases,9 ases of death,no case complaint it.Conclusions Inter-hospital transportation is a new pre-hospital technology,we can provide our patients with good quality of medical service,but we need to do with preparation before moving,and should done well with risk prevention and treatment,which may exist throughout all aspects of the referral process.