以风险评估和干预为主导的确认单在急诊危重患者转运中的应用

Effectiveness of implementing a confirmation sheet centered on risk assessment and intervention during transportation of critically ill patients

目的探讨以风险评估和干预为标准的确认单对急诊危重患者转运不良事件发生率的影响。方法成立专家小组并编制《以风险因素评估和干预实施为目的的危重症患者转运确认单》,比较实施前后危重患者转运中不良事件的发生率。结果实施后不良事件发生率由实施前的34.62%(270/708)下降至18.98%(136/716),实施前后比较,差异具有统计学意义(χ~2=32.103,P<0.001)。其中,病情恶化不良事件发生率较实施前有所降低,但实施前后比较,差异无统计学意义;技术性不良事件发生率由实施前26.55%(188/708)下降至7.82%(56/716),实施前后比较,差异具有统计学意义(χ~2=87.978,P<0.001);其中因技术性问题的不良事件发生率由转运前的25.42%(180/708)下降至7.45%(54/716),实施前后比较,差异具有统计学意义(χ~2=63.420,P<0.001)。结论《以风险因素评估和干预实施为目的的危重症患者转运确认单》作为指导转运工具,能有效降低急诊危重症患者的转运不良事件发生率,提高患者转运中的安全。

Objective The objective of this study was to explore the effectiveness of implementing a confirmation sheet centered on risk assessment and intervention of adverse events during transportation of critically ill patients. Methods The confirmation sheet, based on risk assessment and intervention during adverse events, was compiled by a panel of experts. The incidence of adverse events was compared before and after the implementation. Results The overall incidence of adverse events declined from 34.62%（270/708） to 18.98%（136/716）, and the difference was statistically significant（χ2=32.103,P0.001）. The incidence of deterioration was lower than before implementation, but the difference was not statistically significant; the incidence of technical adverse events decreased from 26.55%（188/708） to 7.82%（56/716）, and the difference was statistically significant（χ2=87.978,P0.001）; and the incidence of adverse events induced by technical problems decreased from 25.42%（180/708） to 7.45%（54/716） and the difference was statistically significant（χ2=63.420,P0.001）. Conclusions The application of a transport confirmation sheet can effectively reduce the incidence of adverse events and improve the safety of critically ill patients during transportation.