多学科合作的流程管理在急诊危重症患者院内转运中的应用效果

Application effect of multidisciplinary cooperation process management in emergency critical care patients in hospital transportation

目的分析多学科合作的流程管理应用于急诊危重症患者院内转运的效果。方法选择上海交通大学医学院附属第九人民医院急诊科380例院内转运患者,按随机数字表法分为对照组和观察组各190例,观察组采用多学科流程管理院内转运,流程管理包括成立急诊科危重患者院内转运小组,多学科共同制定转运流程图,各项工作按流程图进行转运和管理。对照组采用急诊常规流程转运。比较2组患者院内转运过程中护理缺陷率的变化及患者家属的满意度。结果多学科合作的流程管理使急诊危重患者院内转运从单项操作到多学科协作,2组危重症患者转运过程中护理缺陷比较,结果显示,意外拔管发生率从4.2%降低到1.9%;转运前评估漏项发生率从4.7%下降到1.6%;输液管脱落或阻塞从5.3%降到1.1%;改良早期预警评分(MEWS评分)率从4.7%降到1.1%,2组患者在转运过程中不良事件发生率比较观察组明显低于对照组,差异有统计学意义(P<0.001);2组患者家属对转运过程的医患沟通、转运中护理、接诊科室接诊满意度比较,观察组明显高于对照组,差异有统计学意义(均P<0.001)。结论多学科合作流程管理方式的应用,体现了双向或多科合作的优势,使院内转运流程更为流程化、系统化,确保了危重症患者转运过程中的安全性和高效率;促进转运质量的改进,提高患者家属满意度。

Objective To analyze the effect of multidisciplinary collaborative process management on hospital transport of critical patients in emergency department. Methods Three hundred and eighty patients in emergency department from January 2017 to December 2017 were randomly divided into the control group and the observation group, 190 patients in each group. The observation group was managed in-hospital transport by using multidisciplinary process management. The process management included the establishment of in-hospital transport group for critical patients in emergency department, and multidisciplinary joint development of transport flow chart. The control group was transported by emergency routine procedure. The changes of nursing defect rate and satisfaction degree of family members were compared between the two groups. Results Multidisciplinary collaborative process management led to the transfer of critical patients from single operation to multi-disciplinary collaboration. Nursing deficiencies were compared between the two groups. This study showed that the incidence of accidental extubation was reduced from 4.2% to 1.9%;the incidence of missing items was decreased from 4.7% to 1.6%;the incidence of transfusion tube shedding or obstruction was reduced from 5.3% to 1.1%;MEWS score rate was from 4.7% to 1.1%. The incidence of adverse events in the two groups was significantly lower than that in the control group, the difference was statistically significant(P<0.001). The satisfaction degree of the observation group was significantly higher than that of the control group(P<0.001). Conclusion The application of multi-disciplinary cooperative process management embodies the advantages of two-way or multi-disciplinary cooperation, makes the hospital transfer process more streamlined and systematic, ensures the safety and efficiency of critical patients in the process of transport, promotes the improvement of transport quality and improves the satisfaction of patients’ family members.