新型冠状病毒肺炎疫情下急诊就诊患者特点及急诊预检分诊流程改进分析

The characteristics of emergency patients under COVID-19 epidemic situation and the safety and feasibility of the new emergency triage algorithm

目的 观察新型冠状病毒肺炎(COVID-19)疫情下急诊就诊患者特点,探讨COVID-19预检分诊流程的安全性和可行性.方法 比较天津市启动重大突发公共卫生事件一级响应后1个月内与2019年同期急诊接诊患者总人次数、120接诊人次数、抢救室人次数、抢救室患者病情严重程度及收入院情况.观察一级响应后1个月内急诊就诊患者中COVID-19疑似病例数、确诊病例数.结果 2020年一级响应后1个月内急诊接诊总人次数较2019年同期下降59%,而抢救室接诊人次数仅下降23%,观察室留观人次数下降26%.抢救室接诊患者中,2020年一级响应后1个月内与2019年同期比较,65岁以上患者分别占67%和37%,Ⅰ级患者分别占47%和15%,Ⅱ级患者分别占43%和42%.一级响应后1个月内急诊科和发热门诊符合疑似诊断标准患者人数分别为23例和137例,确诊患者人数分别为0和5例.结论 应用针对COVID-19疫情所改进的急诊预检分诊流程,能够安全有效地将COVID-19患者阻隔在急诊诊区之外,还可将发热患者定向转往发热门诊,保证急诊就诊患者安全.COVID-19疫情下急诊就诊患者急危重症比例增高,建议医疗系统落实分级诊疗制度,避免大量非急诊患者占用急诊资源.

Objective To observe the characteristics of emergency patients under coronavirus disease 2019(COVID-19)epidemic situation and to explore the safety and feasibility of the new emergency triage algorithm.Methods To observe the total number of emergency patients,the number of 120 patients,the number of patients in the resuscitation room,the severity of patients in the resuscitation room,and the situation of their admission to the hospital.The data within one month after the launch of the first level response were compared with the data of the same period in 2019 in Emergency Department of Tianjin Medical University General Hospital.The number of suspected cases and confirmed cases of COVID-19 were observed.Results In 2020,the total number of emergency patients decreased by 59%compared with the same period in 2019,while the number of patients in resuscitation room decreased by 23%,and the number of patients in observation room decreased by 26%.The patients in 2020 compared with the same period in 2019,67%vs 37%of patients over 65 years old,47%vs 15%of patients in grade I,43%vs 42%of patients in grade II in resuscitation room.Within one month after the first level response,the number of patients in emergency department and fever clinic who met the suspected diagnostic criteria was 23 and 137 respectively,and the number of confirmed patients was 0 and 5 respectively.Conclusion The application of the improved emergency triage algorithm for COVID-19 could effectively and safely block the COVID-19 patients from the emergency department,and could transfer the fever patients to the fever clinic to ensure the safety of the emergency patients.Under the COVID-19 epidemic situation,the proportion of emergency and critical patients increase.It is suggested that the medical system should implement a hierarchical diagnosis and treatment system to avoid a large number of non-emergency patients occupying emergency resources.