急危重症患者CT检查分检评估方案的构建与初步应用

Construction and preliminary application of CT examination classification and evaluation scheme for patients with acute critical ill

目的探讨急危重症患者CT检查快速分检评估方法。方法通过文献研究、小组讨论、临床预调研等方法形成急危重症患者CT检查分检评估方案条目池;通过2轮德尔菲专家咨询对条目进行修订和调整,形成急危重症CT检查分检评估方案。2019年4月对重庆市某三级甲等医院31名影像科护士进行评估方案的培训,并将分检评估方案用于实践,比较应用前(2018年6-12月)和应用后(2019年4-10月)各级急危重症患者检查平均耗时和患者检查及时性。结果经两轮咨询后,专家熟悉系数为0.790,判断系数为0.975,专家权威系数分别为0.768、0.873。各级指标的变异系数为0~0.114,协调系数为0.538(均P<0.01)。最终分检评估方案,包括一级指标5项、二级指标30项、三级指标8项。应用急危重症CT检查分检评估方案后,患者检查及时性从83%提高至96%,差异有统计学意义(χ^(2)=29.297,P<0.01);患者病情变化发生率从1.3%下降至0(χ^(2)=4.235,P<0.05),临床医生满意度均有提高,差异有统计学意义(P<0.01)。结论急危重症患者CT检查分检评估方案的使用简单快捷,可为影像科护士对患者的分检评估决策提供评判依据,提高患者检查的时效性及临床医生的满意度,保障患者检查安全性。

Objective To investigate the CT examination rapid classification and assessment method for the patients with acute critical ill.Methods The item pool of CT examination classification evaluation scheme for critical ill patients was formed by the methods such as the literature research,group discussions,clinical pre-surveys,etc.The items were revised and adjusted by the two rounds of Delphi(Delphi)expert consultation to form the acute and critical ill CT examination classification and assessment scheme.In April 2019,31 nurses in the imaging department of a tertiary hospital in Chongqing City conducted the assessment scheme training,and the classification and assessment scheme was used in practice.The average time-consuming of examination and patients examination timeliness of all levels of patients were compared between before application(June-December 2018)and after application(April-October 2019).Results After the two rounds of consultation,the expert familiarity coefficient was 0.790,the judgment coefficient was 0.975,and the expert authority coefficients were 0.768 and 0.873,respectively.The coefficient of variation of indicators at different levels was 0-0.114,the coordination coefficient was 0.538(allP<0.01).The final classification and assessment scheme included 5 first-level indicators,30 second-level indicators,and 8 third-level indicators.After applying the acute and critical ill CT examination classification and assessment scheme,the timeliness of the patient′s examination was increased from 83%to 96%,the difference was statistically significant(χ^(2)=29.297,P<0.01);the change rate of the patient′s disease condition was decreased from 1.3%to 0(χ^(2)=4.235,P<0.05),the clinicians′satisfaction was increased significantly,and the difference was statistically significant(P<0.01).Conclusion The use of the CT examination classification and assessment scheme for acute critical ill patients is simple and quick,which can provide a judgment basis for imaging nurses making the classification and assessment decisions,improve the timeliness of patient examinations,and the satisfaction of clinicians.The safety of the patient examination is guaranteed.