急性缺血性卒中再灌注治疗医疗质量改进及流程优化研究

Study on medical quality improvement and process optimization of acute ischemic stroke reperfusion therapy

目的通过持续的多模式医疗质量改进干预措施及流程优化研究,提高急性缺血性卒中静脉溶栓的指南依从率,缩短院内延迟时间。方法选取天津市西青医院从2017年5月—2019年12月连续收治的743例急性缺血性卒中患者作为研究对象,按照具体干预手段不同分为四个时期,比较四个时期溶栓率、入院-接诊时间、入院-CT时间、入院-溶栓时间及卒中快速识别率。结果随着项目干预手段的持续推进,溶栓率由基线水平49.75%升高至92.31%;患者入院到接诊时间由基线水平15分钟缩短至3分钟;入院到CT完成时间由基线水平36.94分钟缩短至7.96分钟;入院到溶栓时间由基线水平46.82分钟缩短至25.92分钟;分诊台护士卒中快速识别率由干预第二阶段的61.36%提升至84.21%,差异均具有统计学意义(P<0.05)。结论卒中医疗质量改进措施可有效改善卒中关键绩效指标,将急性缺血性卒中急救信息一体化平台融入急性缺血性卒中急救是流程进行优化的创新。

Objective Through continuous multi-modal medical quality improvement intervention measures and process optimization research,improve the compliance rate of the guidelines for intravenous thrombolysis in acute ischemic stroke and shorten the delay time in the hospital.Methods A total of 743 patients with acute ischemic stroke who were consecutively treated in Tianjin Xiqing Hospital from May 2017 to December 2019 were selected as the research objects.They were divided into four periods according to the specific intervention methods,and the four periods were compared for thrombolysis.Rate,door to neurological physician time,door to imaging completed time,door to needle time,and rapid stroke identification rate.Results With the continuous advancement of project interventions,the rate of thrombolysis increased from the baseline level of 49.75%to 92.31%;the time from admission to reception of patients was shortened from the baseline level of 15 minutes to 3 minutes;the time from admission to the completion of CT was shortened from the baseline level of 36.94 minutes To 7.96 minutes;the time from admission to thrombolysis was shortened from the baseline level of 46.82 minutes to 25.92 minutes;the rapid recognition rate of stroke among triage nurses increased from 61.36%in the second phase of intervention to 84.21%,and the differences were statistically significant(P<0.05).Conclusion Stroke medical quality improvement measures can effectively improve the key performance indicators of stroke.Integrating the acute ischemic stroke emergency information integration platform into the acute ischemic stroke emergency response is an innovation of process optimization.