基层胸痛中心建设效果评价及质控策略

Effectiveness evaluation and quality control strategy at primary-level chest pain centers

对2017年7月至2019年6月上海市嘉定区南翔医院通过胸痛中心数据填报平台实时抓取的胸痛救治患者在线上报数据进行研究分析。结果显示,首次医疗接触后完成心电图检查月平均时间1.3~6.9 min,中位1.9(1.7,2.2)min,符合10 min内完成的质控要求;获取肌钙蛋白检测结果所需时间13.0~48.4 min,中位14.1(13.4,18.1)min,符合质控20 min内完成的要求;从入门至转出经皮冠状动脉介入治疗患者的时间19.0~100.0 min,中位37.2(29.3,66.6)min,基本达到质控要求的30 min;ST段抬高型心肌梗死患者进导管室率50.0%~100.0%,中位100.0%(73.3%,100.0%),符合质控≥50%的要求。胸痛中心经过积极建设主要质控指标管控良好,上报病例数基本稳定,病种分布基本合理。在转运知情告知和在低危胸痛患者后续处置上需进一步加强。提示胸痛中心建设要建立长效常态工作机制,要加强对重点质控指标的管控,胸痛中心建设要发挥区域救治体系作用。

The real-time reported data of treated patients from July 2017 to June 2019 Nanxiang Hospital of Jiading District were collected from chest pain center platform.The results showed that the average time of completing ECG examination from the first medical contact was 1.3 to 6.9 min with a median of 1.9 min(1.7,2.2),meeting the quality control requirements(10 min);the time required to obtain troponin test results was 13.0 to 48.4 min with a median of 14.1 min(13.4,18.1),meeting the requirements for quality control of 20 min;time from entry to transfer out of PCI patients was 19.0-100.0 min,with median 37.2(29.3,66.6)min,basically reaching quality control(30 min);the entering catheter chamber rate of STEMI patients was 50.0%to 100.0%with a median of 100.0%(73.3%,100.0%),meeting the requirements of quality control(≥50%).Through the active construction,the main quality control indicators were well reached,the reported cases were basically stable,and the disease distribution was basically reasonable in the primary-level chest pain centers.Informed notification of transshipment and subsequent management of low-risk chest pain patients need to be further strengthened.It is suggested that the construction of chest pain centers should establish long-term normal working mechanism,strengthening the control of key quality control indicators,to play the important role of the regional treatment system.