德尔菲法在研制非创伤性胸痛患者急诊分诊标准中的应用

Application of Delphi method in the development of emergency triage criteria for patients with non-traumatic chest pain

目的构建适合我国急诊护士使用的非创伤性胸痛患者的分诊工具。方法以《医院急诊科规范化流程》为框架,通过阅读国内外相关文献、对分诊护士的深入访谈以及临床观察,初步设计非创伤性胸痛患者分诊条目,并将患者病情危重程度分为3级。采用德尔菲专家咨询法,通过对27名专家的2轮咨询,初步筛选并确定指标和分级标准。结果2轮问卷有效回收率分别为100%和96.1%;专家权威系数为0.75和0.78,2轮专家咨询的Kendall's W分别为0.397和0.487(P<0.01)。2轮专家咨询后得出的指标的变异系数范围为0.00~0.22。经2轮专家咨询最终确定5个分诊指标(胸痛特点、心率、收缩压、指脉氧、心电图),每个指标按危险程度分为Ⅰ、Ⅱ、Ⅲ级。结论应用德尔菲法对非创伤性胸痛患者急诊分诊标准的各项指标进行筛选,具有较高的可靠性与科学性,适合急诊护理人员使用。

Objective To construct a suitable triage tool foremergency nurses in China for patients with non-traumatic chest pain.Methods Based on the framework of"Standardized Procedure of Hospital Emergency Departments",through reading the relevant literature at home and abroad,in-depth interviews with triage nurses and clinical observation,a preliminary design of triage items for patients with non-traumatic chest pain was made,and the severity of patients was divided into three levels.Using Delphi expert consultation method,through two rounds of consultation with 27 experts,preliminary indicators and classification criteria were extracted and determined.Results The effective recovery rates of the two rounds of questionnaires were 100%and 96.1%,respectively;the expert authority coefficient was 0.75 and 0.78,and the Kendall's W coordination coefficient of the two rounds of expert consultation was 0.397 and 0.487(P<0.01).After two rounds of expert consultation,the coefficient of variation of the indicators ranged from 0.00 to 0.22.After two rounds of expert consultation,five indicators(chest pain characteristics,heart rate,systolic blood pressure,finger pulse oxygen,electrocardiogram)in triage were finally determined.Each index was classified intoⅠ,ⅡandⅢaccording to the critical degree.Conclusions The application of Delphi method in determining the indicators of emergency triage criteria for patients with non-traumatic chest pain has high reliability and scientificity,and is suitable for emergency nurses to use.