三种急危症24小时诊疗数据与临床路径标准的对比分析

Comparative analysis of diagnosis and treatment data and clinical pathway standards of three kinds of acute and critical diseases within 24 hours

目的对三种急危症24小时诊疗数据与临床路径标准进行对比,分析实际诊疗与路径标准的差异,探讨临床路径合理性及实用可行性仍存在的问题。方法收集、统计解放军总医院第一医学中心急诊科2020年1月到2020年12月全年救治的符合纳入标准的320例急性消化道出血、134例急性心肌梗死和117例脑出血患者急诊24小时内的实际诊疗数据,根据疾病诊疗指南,与相关临床路径标准进行对比,查找实际诊疗数据与临床路径标准之间的差异,分析差异出现的原因,并提出优化建议。结果三种急危症的临床路径标准检查实际应用比率分别为:急性消化道出血与脑出血均为100%,急性心肌梗死为82.35%。符合率50%以上的检查项目在三种急危症的构成比分别为:急性消化道出血84.62%,急性心肌梗死47.06%,脑出血71.43%。超出路径标准的检查分别为:急性消化道出血9项,急性心肌梗死7项,脑出血4项。实际治疗与路径标准基本相符。结论三种急危症诊疗状况与现行临床路径标准基本符合,但仍存在未能按临床路径标准规范实施和超标准诊疗的情况,应在实际应用中不断规范和优化急危症临床路径标准。

Objective To compare the diagnosis and treatment data with clinical pathway standards of three kinds of emergency and critical diseases within 24 hours,to analyze the differences between actual diagnosis and treatment and pathway standards,and to explore the remaining problems of the rationality and practical feasibility of clinical pathways.Methods We collected and counted actual diagnosis and treatment data of 320 cases of acute gastrointestinal hemorrhage,134 cases of acute myocardial infarction,and 117 cases of cerebral hemorrhage in the emergency rescue room of the First Medical Center of the PLA General Hospital from January 2020 to December 2020 that met the inclusion criteria.According to the disease diagnosis and treatment guidelines,we compared the actual diagnosis and treatment data with the corresponding clinical pathway standards,found the differences between them,analyzed the reasons for the differences,and proposed optimization suggestions.Results The actual application rates of clinical pathway standard examinations for the three emergency and severe diseases were as follow:acute gastrointestinal hemorrhage and cerebral hemorrhage were 100%,and acute myocardial infarction was 82.35%.The composition ratios of the examination items with a coincidence rate of more than 50%in acute gastrointestinal bleeding,acute myocardial infarction and cerebral hemorrhage were 84.62%,47.06%,71.43%respectively.There were 9 items of acute gastrointestinal hemorrhage,7 items of acute myocardial infarction,and 4 items of cerebral hemorrhage that exceeded the clinical pathway standards.The actual treatment was basically in line with the pathway standards.Conclusions The diagnosis and treatment conditions of the three kinds of acute diseases are basically in line with the current clinical pathway standards,but there are still cases of failure to implement clinical pathway standards and diagnosis and treatment that exceed the standards.It is necessary to continuously standardize and optimize the emergency clinical pathway standards in practical applications.