患者危重分级处理在急诊CT检查中的实践

Practice of critical grading treatment in emergency CT examination

目的探究依据患者危重分级决定急诊CT检查优先顺序的应用价值。方法收集2018年1月10日起连续两周在本院急诊CT接受检查的患者。首周收集患者427例,设为对照组,以急诊FLAETS患者危急程度分级标准对患者进行评价,按患者到检先后顺序进行检查。第二周收集患者461例,设为实验组,以FLAETS分级标准为依据,按危重级别接受检查。具体分级如下:1级(濒危、危重),对应FLAETSⅠ、Ⅱ级患者,立刻接受检查;2级(急症),对应FLAETS Ⅲ级患者,完成1级患者检查后,优于3级患者检查;3级(非急症),对应FLAETS Ⅳ、Ⅴ级患者,在完成1、2级患者检查后,按到检顺序就诊。检查前,患者均被告知相应的接受检查顺序依据,检查后进行就诊满意度调查,按1～5分打分,1分为十分不满意,3分为合格,5分为十分满意。结果实验组有1～3级患者分别为92例,323例和46例。对照组有1～3级患者分别为85例,289例和53例。两组患者危重程度分布差异无统计学意义。实验组1～3级患者平均候诊时间分别为2.54 min,16.57 min和29.35 min。对照组1～3级患者平均候诊时间分别为13.91 min,16.98 min和18.02 min。实验组较对照组,1级患者候诊时间明显缩短,2级患者候诊时间稍缩短,差异有统计学意义(P<0.05),3级患者候诊时间明显加长。就诊满意度调查,实验组各级患者打分均高于对照组,1、2级患者满意度均达优秀(>4分),3级患者满意度也合格(≥3分)。对照组1级患者满意度不合格(<3分)。结论传统不分诊的检查方式操作简单,但明显延长了危重患者就诊时间,可能导致患者病情加重及治疗延误,增加患者风险,给患者的就诊体验也最差。实行按危重级别分诊检查后,可优化急诊CT检查资源,明显加快危重患者就诊,而对于非急症患者,在提前告知分诊就诊原则后,也能得到患者理解,整体提高患者就诊满意度。最终达到合理化分配,人尽其力,物尽其用的服务理念,满足医患双方需求,可在临床方面运用。

Objective To explore the application value of emergency CT examination priority based on patients’ critical grading. Methods Patients undergoing emergency CT examination in our hospital in two consecutive weeks from January 10, 2018 were collected. 427 cases of patients were collected in the first week as the control group. These patients were evaluated by the critical level standard of emergency FLAETS, but the patients were checked in the order of arrival. In the second week, 461 patients were collected as the experimental group. They were examined according to the severity of illness that evaluated by FLAETS grading standard. Grading standard is as follows: Level 1(endangered or critical patients), corresponding to FLAETS Ⅰ and Ⅱ, should accept examination immediately. Level 2(emergency patients), corresponding to the FLAETS Ⅲ, should get examination just after level a patuents and before level 3 patients. Level 3(non-emergency patients), corresponding to the FLAETS Ⅳ and Ⅴ, should get examination after level 1 and 2 patients. Before the examination, all patients were informed of the corresponding order of examination, and satisfaction survey was conducted after examination. The scores were divided into 1-5 points, 1 was very dissatisfied, 3 was qualified and 5 was very satisfied. Results There were 92, 323 and 46 patients corresponding to level 1-3 patients respectively in the experimental group. And 85, 289 and 53 patients corresponding to level 1-3 patients respectively, were collected in the control group. There was no significant difference in the distribution of critical severity between the two groups. The average waiting time of the 1-3 grade patients in the experimental group was 2.54 minutes, 16.57 minutes and 29.35 minutes respectively. The average waiting time of 1-3 grade patients in the control group was 13.91 minutes, 16.98 minutes and 18.02 minutes respectively. Compared with the control group, the waiting time for level 1 patients was significantly shortened, and the waiting time for level 2 patients was slightly shorter, but also had statistical difference(P<0.05). The waiting time for level 3 patients was significantly longer. The satisfaction scores of patients at all levels in the experimental group were higher than those in the control group. The satisfaction of level 1 and 2 patients reached excellent(>4 points), and the degree of satisfaction of level 3 patients was also qualified(≥3 points). The level 1 patients’ satisfaction degree in the control group were not unqualified(<3 points). Conclusion The traditional examination flow without triage is easy to operate, but it obviously prolongs the time of treatment for critically ill patients. It may lead to the aggravation of the patient and the delay of treatment, increase the risk of the patient and the worst experience of the patient. After the implementation of the critical grade examination, the emergency CT examination resources can be optimized and the critically ill patients can be significantly examined quickly, while for the non-emergency patients, the early notification of triage principle can also help the patients understand and improve their satisfaction. Finally, we can achieve the rationalization of distribution of people and inspection equipment to do their best and meet the needs of both doctors and patients, which can be applied in clinical practice.