信息化流程管理系统在急性缺血性卒中救治中的构建及应用

Construction and application of information process management system in the treatment of acute ischemic stroke

目的探讨信息化流程管理系统在急性缺血性卒中(AIS)救治中的构建及实践中的应用情况。方法回顾性分析2017年8月至11月于第二军医大学附属长海医院脑血管病中心接受卒中绿色通道救治,并且纳入信息化流程管理系统的597例疑似卒中患者的临床资料,评价AIS救治流程中各环节运行现状以及运行效率。对卒中护士和接诊医师制定绩效考核指标,计算卒中护士判定卒中的准确率及漏诊率;以医师到达预检台-建立静脉通道时间和签署知情同意书-静脉团注重组组织型纤溶酶原激活剂(rt-PA)时间评价卒中护士救治操作能力,达标时间<10 min;以呼叫接诊医师-医师到达预检台和建立静脉通道-转运至CT室时间评价接诊医师应急处理能力,达标时间<5 min,计算达标率。结果 597例预检判定为疑似卒中患者中,医师判定为卒中549例,建立静脉通道430例,转运至CT室443例,完成头部CT平扫441例,静脉溶栓52例。流程中患者到院-医师到达预检台、医师到达预检台-建立静脉通道、建立静脉通道-转运至CT室、转运至CT室-完成CT平扫、完成CT平扫-团注rt-PA时间、患者到院-完成CT平扫及患者到院-团注rt-PA的中位数时间分别为3(1,5)、8(3,16)、3(2,5)、3(2,9)、9(3,22)、20(10,30)、27(19,55)min。卒中护士判定卒中的准确率、漏诊率分别为92.0%(549/597)、8.4%(50/597);医师到达预检台-建立静脉通道、签署知情同意书-团注rt-PA时间达标率分别为82.1%(353/430)、80.8%(42/52)。呼叫接诊医师-医师到达预检台、建立静脉通道-转运至CT室时间达标率分别为94.5%(564/597)、91.4%(405/443)。结论以"时间管理"为核心的流程管理系统可以帮助分析AIS救治流程中各种环节和各种人员的效率,不断优化流程。

ObJective To investigate the construction and application in practice of intormation process management system in the treatment of acute ischemic stroke （AIS）. Methods From August 2017 to November 2017 ,the clinical data of the 597 patients with suspected stroke received green channel treatment for stroke and incorporated into the information process management system at the Cerebrovascular Disease Center, Changhai Hospital ,the Second Military Medical University were analyzed retrospectively. The operation status and operational efficiency of each link in the AIS treatment process were evaluated. The performance assessment indicators for stroke nurses and visiting doctors were developed. The accuracy and missed diagnosis of stroke determined by the stroke nurses were calculated. The operation ability of stroke nurses was evaluated by the doctor＇s arrival at triage desk to establishment of intravenous access time and