基于创伤团队激活模式的持续质量改进在急诊预检分诊中的应用

Application of continuous quality improvement based on trauma team activation model in emergency triage

目的:探讨基于创伤团队激活模式的持续质量改进在急诊预检分诊中的应用效果。方法:本研究为历史对照研究。采用便利抽样法,选取2020年1月—2021年6月在南京医科大学第一附属医院急诊初次就诊的12 215例创伤患者为研究对象,将2020年1—6月就诊的3 896例创伤患者作为基线组,2020年7—12月就诊的4 054例患者作为Ⅰ期改进组,2021年1—6月就诊的4 265例患者作为Ⅱ期改进组。基线组采用单层创伤团队激活模式,由首诊医生评估决策;Ⅰ期改进组采用单层创伤团队激活模式,由预检分诊护士评估决策;Ⅱ期改进组采用两层创伤团队激活模式,由预检分诊护士评估决策。比较三组的激活创伤团队时间、分诊过度率及分诊不足率。结果:Ⅰ期改进组、Ⅱ期改进组激活创伤团队时间短于基线组,差异有统计学意义( P<0.05)。Ⅱ期改进组的分诊过度率低于基线组和Ⅰ期改进组,差异有统计学意义( P<0.05)。三组分诊不足率均<5%,差异无统计学意义( P>0.05)。 结论:预检分诊护士主导的两层创伤团队激活模式可缩短激活创伤团队时间,降低分诊不足率及分诊过度率,提高创伤团队激活质量。

Objective To explore the application effect of continuous quality improvement based on trauma team activation model in emergency triage.Methods This study is a historical controlled study.A total of 12215 trauma patients receiving initial treatment in the Emergency Department of the First Affiliated Hospital with Nanjing Medical University from January 2020 to June 2021 were selected as the research objects by the convenience sampling method,and 3896 trauma patients from January to June 2020 were enrolled as the baseline group,and 4054 patients from July to December 2020 were enrolled as the phaseⅠimprovement group,and 4265 patients from January to June 2021 were enrolled as the phaseⅡimprovement group.The baseline group adopted the one-tiered trauma team activation model,which was evaluated and decided by the first-visiting doctor.The phaseⅠimprovement group received the one-tiered trauma team activation model,which was evaluated and decided by pretest triage nurses.The stageⅡimprovement group conducted the two-tiered trauma team activation model,which was evaluated and decided by pretest triage nurses.The trauma team activation time,overtriage rate and undertriage rate were compared between the three groups.Results The trauma team activation time of the phaseⅠimprovement group and phaseⅡimprovement group was shorter than that of the baseline group,and the difference was statistically significant(P<0.05).The overtriage rate of the phaseⅡimprovement group was lower than that of the baseline group and the phaseⅠimprovement group,and the differences were statistically significant(P<0.05).The underage rate of the three groups were<5%,and the differences were not statistically significant(P>0.05).Conclusions The two-tiered activation of trauma team mode led by nurses can shorten the trauma team activation time,reduce the overtriage rate and undertriage rate,improve the quality of trauma team activation.