急诊患者院内转运流程的持续改进

A quality improvement program of intrahospital transport of critically ill patients from emergency department

目的提高急诊危重患者院内转运安全性。方法将急诊科4 899例急诊危重患者按时间段分为对照组1 651例、观察1组1 568例、观察2组1 680例。对照组根据改良早期预警评分(MEWS)按常规方式转运,观察1组成立医护工转运小组,在MEWS的基础上增加SpO2及GCS评分形成基于MEWS评分的综合评估系统对患者进行评估和转运;观察2组再增加团队配合培训。结果观察1组、2组4项意外事件除输液外渗或堵塞1项外,另3项发生率显著低于对照组(均P<0.0125);转运时间显著长于对照组(均P<0.05)。结论基于MEWS评分的综合评估系统的应用及持续质量改进,可有效提高急诊科危重患者院内转运安全性。

Objective To improve safety of intrahospital transport of critically ill patients from emergency department. Methods To- tally, 4 899 critically ill patients were divided into three groups chronologically. The control group （n= 1 651） was given routine transport which was guided by the Modified Early Warning System （MEWS）, while the two observation groups （n= 1 568 and 1 680 respectively） received improved transport： a transport team was formed of a doctor, a nurse and a worker, and a comprehen- sive assessment system was developed, including the MEWS, peripheral oxygen saturation （SpO_2） and Glasgow score, to guide the assessment and transport. The observation group 2 additionally received team training. Results Except intravenous infusion ex travasation or blockage, the incidence rates of three adverse events were significantly lower, whereas the time for transport was significantly longer, in the two observation groups than those in the control group （P〈0. 0125, P〈0.05）. Conclusion Using the comprehensive assessment system and conducting continuous improvement can effectively improve the safety of intrahospital trans- port of critically ill patients from emergency department.