Risk assessment of the emergency processes： Healthcare failure mode and effect analysis

BACKGROUND: Ensuring about the patient's safety is the f irst vital step in improving the quality of care and the emergency ward is known as a high-risk area in treatment health care. The present study was conducted to evaluate the selected risk processes of emergency surgery department of a treatment-educational Qaem center in Mashhad by using analysis method of the conditions and failure effects in health care.METHODS: In this study, in combination(qualitative action research and quantitative crosssectional), failure modes and effects of 5 high-risk procedures of the emergency surgery department were identified and analyzed according to Healthcare Failure Mode and Effects Analysis(HFMEA). To classify the failure modes from the "nursing errors in clinical management model(NECM)", the classification of the effective causes of error from "Eindhoven model" and determination of the strategies to improve from the "theory of solving problem by an inventive method" were used. To analyze the quantitative data of descriptive statistics(total points) and to analyze the qualitative data, content analysis and agreement of comments of the members were used.RESULTS: In 5 selected processes by "voting method using rating", 23 steps, 61 sub-processes and 217 potential failure modes were identifi ed by HFMEA. 25(11.5%) failure modes as the high risk errors were detected and transferred to the decision tree. The most and the least failure modes were placed in the categories of care errors(54.7%) and knowledge and skill(9.5%), respectively. Also, 29.4% of preventive measures were in the category of human resource management strategy.CONCLUSION: "Revision and re-engineering of processes", "continuous monitoring of the works", "preparation and revision of operating procedures and policies", "developing the criteria for evaluating the performance of the personnel", "designing a suitable educational content for needs of employee", "training patients", "reducing the workload and power shortage", "improving team communication" and "preventive management of equipment's" were on the agenda as the guidelines.

Impact of failure mode and effects analysis-based emergency management on the effectiveness of craniocerebral injury treatment

BACKGROUND Craniocerebral injuries encompass brain injuries,skull fractures,cranial soft tissue injuries,and similar injuries.Recently,the incidence of craniocerebral injuries has increased dramatically due to the increased numbers of traffic accidents and aerial work injuries,threatening the physical and mental health of patients.AIM To investigate the impact of failure modes and effects analysis(FMEA)-based emergency management on craniocerebral injury treatment effectiveness.METHODS Eighty-four patients with craniocerebral injuries,treated at our hospital from November 2019 to March 2021,were selected and assigned,using the random number table method,to study(n=42)and control(n=42)groups.Patients in the control group received conventional management while those in the study group received FMEA theory-based emergency management,based on the control group.Pre-and post-interventions,details regarding the emergency situation;levels of inflammatory stress indicators[Interleukin-6(IL-6),C-reactive protein(CRP),and procalcitonin(PCT)];incidence of complications;prognoses;and satisfaction regarding patient care were evaluated for both groups.RESULTS For the study group,the assessed parameters[pre-hospital emergency response time(9.13±2.37 min),time to receive a consultation(2.39±0.44 min),time needed to report imaging findings(1.15±4.44 min),and test reporting time(32.19±6.23 min)]were shorter than those for the control group(12.78±4.06 min,3.58±0.71 min,33.49±5.51 min,50.41±11.45 min,respectively;P<0.05).Pre-intervention serum levels of IL-6(78.71±27.59 pg/mL),CRP(19.80±6.77 mg/L),and PCT(3.66±1.82 ng/mL)in the study group patients were not significantly different from those in the control group patients(81.31±32.11 pg/mL,21.29±8.02 mg/L,and 3.95±2.11 ng/mL respectively;P>0.05);post-intervention serum indicator levels were lower in both groups than pre-intervention levels.Further,serum levels of IL-6(17.35±5.33 pg/mL),CRP(2.27±0.56 mg/L),and PCT(0.22±0.07 ng/mL)were lower in the study group than in the control group(30.15±12.38 pg/mL,3.13±0.77 mg/L,0.38±0.12 ng/mL,respectively;P<0.05).The complication rate observed in the study group(9.52%)was lower than that in the control group(26.19%,P<0.05).The prognoses for the study group patients were better than those for the control patients(P<0.05).Patient care satisfaction was higher in the study group(95.24%)than in the control group(78.57%,P<0.05).CONCLUSION FMEA-based craniocerebral injury management effectively shortens the time spent on emergency care,reduces inflammatory stress and complication risk levels,and helps improve patient prognoses,while achieving high patient care satisfaction levels.

Fever Outpatient Service of General Hospital Applies “1 + 3 + 3” Emergency Management Mode to Deal with COVID-19 Pandemic

Purpose: To discuss the effect of “1 + 3 + 3” emergency management mode to deal with COVID-19 pandemic in fever outpatient service of general hospitals. Method: This paper analyzes and summarizes the problems encountered by fever outpatient service in dealing with the COVID-19 pandemic from three aspects of “One Team”, “Three-Key” Control and “Three Mosts”. Results: The application of “1 + 3 + 3” emergency management mode can effectively boost the orderliness and efficiency of fever outpatient service in dealing with COVID-19 pandemic. Conclusion: The “1 + 3 + 3” emergency management mode provides a new management mode and idea for dealing with COVID-19 pandemic, so the fever outpatient service of general hospitals can better improve the national overall anti-pandemic situation.

Clinical Effect of Intelligent Emergency Nursing Mode in Patients with Severe Traumatic Brain Injury

Objective: Severe traumatic brain injury (sTBI) is one of the common acute and critical diseases in neurosurgery. So we aim to explore the clinical effectiveness of an intelligent emergency care model in patients with severe traumatic brain injury. Methods: Eighty patients with severe traumatic brain injury (sTBI) who were treated in Zhuji People’s Hospital of Zhejiang Province from January 2019 to December 2021 were selected as the study subjects. The patients were divided into an observation group and a control group with 40 patients in each group according to the random number table method. Patients in the control group received conventional first-aid nursing mode intervention, and the intelligent emergency nursing mode was used for the observation group based on the control group. Comparisons were conducted between the two groups on the time of arrival to the emergency room, the time from the emergency room to the operating room, Glasgow Coma Scale (GCS) score before surgery, GCS score when leaving the Intensive Care Unit (ICU), the average length of ICU stay, the average length of hospital stay, the total hospital costs. Results: The time of arrival to the emergency room, the time from the emergency room to the operating room, the average length of ICU stay, the average length of hospital stay, and the total hospital costs in the observation group were significantly lower than those in the control group, and the differences were statistically significant (All P Conclusion: Intelligent emergency nursing mode can shorten the time of sTBI rescue, the length of ICU stay, and the average length of hospital stay, reduce the total hospitalization cost, improve the prognosis, with good efficacy, reduce the total cost of hospitalization, and improve the prognosis with better efficacy.

Exploration of “Integrated Emerging Engineering” Applied Talent Training Mode for Landscape Architecture

Under the background of national promotion of innovation-driven development and Hubei Provincial Department of Education’s proposal to adjust and optimize the layout of higher education disciplines and specialties to serve Hubei as an important strategic pivot for the rise of central region,and based on the regional advantages of Yichang in the urban agglomeration of “Yichang,Jingzhou,Jingmen and Enshi” and the discipline characteristics and construction process of landscape architecture,the exploration and practice of “integrated emerging engineering” talent training mode of landscape architecture in College of Science and Technology of China Three Gorges University are comprehensively summarized from the aspects of teaching system construction,teaching staff construction,curriculum ideological and political construction,service industry and locality,deepening integration of production and education,transformation of scientific research achievements,and second classroom construction,in order to provide a reference for the training of emerging engineering talents in colleges and universities.

Research on the Formation Modes of Emerging Technologies Based on the Species Origin Theory

Based on the research on emerging technologies and ＂the technology species＂, this thesis tries to find out the homologous relations between emerging technology and new species. The theory of the new biology species in synthetic evolution and the modern genetics is referred in the research. The modes of forming emerging technologies are discussed through some examples of IT evolvement according to modes of the biology speciation. Finally, it is pointed out that the biology species origin theory can analogize continuously the research about the evolvement mode of every emerging technology, and the implications have been bought to enterprises based on the formation conditions of each mode.

基于BOPPPS的翻转课堂教学模式在急诊与灾难医学教学中的应用

目的探讨基于BOPPPS的翻转课堂教学模式在急诊与灾难医学教学中的应用效果。方法选取2021年9—11月蚌埠医学院临床医学实验班40名学生作为观察组,采取基于BOPPPS的翻转课堂教学模式学习急诊与灾难医学所有课程。同时选取2020年9—11月蚌埠医学院临床医学实验班40名学生作为对照组,采取传统教学模式学习急诊与灾难医学课程。比较两组学生的期末考试(理论考试和技能考试)成绩及教学效果评价。结果观察组学生的成绩(临床技能和理论知识)高于对照组,差异有统计学意义(P<0.05);观察组对该课程培养了解决问题的能力、该课程提高了分析能力、该课程促进知识的记忆、该课程有助于提高学习动力、有信心解决不熟悉的问题、总的来说对课程很满意的评价高于对照组,差异有统计学意义(P<0.05);观察组对课程过于理论化和抽象化及对这门课有很多压力的评价低于对照组,差异有统计学意义(P<0.05)。结论基于BOPPPS的翻转课堂教学模式有利于培养学生解决问题的能力、分析能力和学习主动性,提高教学效果和质量,在推动医学教学改革方面发挥重要作用。

失效模式和效应分析在急诊抢救记录书写中的应用

目的:探索失效模式和效应分析(FMEA)在急诊抢救记录书写中的应用效果。方法:随机选取2022年1月—6月的300份急诊抢救记录作为对照组,2022年7月—12月的300份急诊抢救记录作为观察组。对照组采用常规质量控制管理,观察组采用FMEA管理,分析抢救记录书写过程中的失效模式及原因,计算优先风险数值,找出前5位的失效模式,分析原因,制订改进措施。比较两组急诊抢救记录书写缺陷情况;比较两组护士护理文书书写相关法律知识及理论知识的掌握情况。结果:观察组共发现缺陷71份,对照组共发现缺陷220份,观察组客观性缺陷、真实性缺陷、准确性缺陷、及时性缺陷、完整性缺陷、规范性缺陷的发生率分别为5.00%、2.67%、2.33%、3.67%、6.67%、3.33%,低于对照组的10.67%、8.33%、7.33%、15.67%、18.67%、12.67%,差异均有统计学意义(P<0.05)。观察组护士护理文书书写相关法律知识成绩(92.54±3.39)分、理论知识成绩(93.08±2.71)分,均高于对照组(75.78±7.14)分、(83.28±4.89)分,差异均有统计学意义(P<0.05)。结论:FMEA模式在急诊抢救记录书写中的应用效果良好,能提高护理文书书写质量及护士的书写能力。

重大突发疫情中的对口支援关系匹配优化研究

重大突发事件中的对口支援是典型的具有中国特色的应急救援措施,也是我国社会制度优越性的重要体现。现有相关研究大多为定性研讨,鲜有从管理科学视角探讨供需双方如何实现匹配优化。研究应急响应阶段中的对口支援关系优化问题,并以全国支援湖北抗击疫情为例:首先从“人”“机”“物”等角度界定支援地供应能力,同时创新定义了受灾地的需求紧迫度和供需匹配函数,然后借鉴指派优化问题的建模思想,以加权的需求满足率最大化为目标函数,构建了应急响应阶段的对口支援结对关系匹配优化模型。计算实验表明:所提出的模型兼顾了应急资源分配的公平性,能最大限度地覆盖灾区需求情况;在资源紧缺和资源充裕两个极端情况下,“物”和“人”分别是提升灾区需求满足率的关键。

新疆地震应急视频会议系统组会模式与常见故障分析

介绍了新疆地震应急视频会议系统常用组会模式、各模式应用场景及其优缺点;分析了视频会议系统常见的硬件设备、软件、网络故障表现特征及日常实例。以宝利通MCU组会故障排除及原因分析为例,提出视频会议故障排查流程,本次故障表明不同硬件设备MTU设置值对网络传输效率有一定的影响。以期对今后网络故障排查提供参考借鉴。

某三甲医院急诊患者安全管理与对策研究

目的应用医疗失效模式与效应分析(healthcare failure mode and effect analysis,HFMEA)对急诊患者进行安全管理,保障急诊患者安全。方法成立HFMEA小组,选择急诊急救案例,绘制急诊急救流程,找出失效原因,计算危害指数。决策树分析后找出需要重点改善的失效原因,利用鱼骨图找出系统原因,拟定改善方案,包括加强信息化管控、以制度规范流程、组建快速反应小组、加强员工培训。结果实施改善方案后,危害指数明显下降。结论HFMEA强调事前干预,对急诊患者急救等高危流程有重大指导意义,可有效减少潜在风险点,提升急诊医疗质量与安全。

精细化护理模式在急诊子痫前期孕妇护理中的应用效果分析

目的:探讨精细化护理模式在急诊子痫前期孕妇护理中的应用效果。方法:选取2017年1月—2022年1月南京医科大学附属妇产医院收治的70例子痫前期孕妇作为研究对象,随机分为两组,各35例。对照组采用常规急诊护理,观察组采用精细化护理。比较两组不良事件发生情况、心理状态、护理满意度。结果:观察组不良事件总发生率低于对照组,差异有统计学意义(P=0.013)。护理前,两组焦虑自评量表(SAS)评分比较,差异无统计学意义(P>0.05);护理后,两组SAS评分低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组护理满意度评分高于对照组,差异有统计学意义(P<0.001)。结论:精细化护理模式在急诊子痫前期孕妇护理中的应用效果显著,可降低不良事件发生率,缓解孕妇焦虑状态,提高护理满意度。

河北省应急物资储备库选址与管理研究

科学的应急物资储备库选址是影响应急物资配送时效和突发公共事件处理效率的关键因素。文章在分析河北省应急物资储备选址问题的基础上,构建集合覆盖模型,并利用启发式算法完成求解。根据模型求解结果,河北省应在保定和廊坊两地建立应急物资储备库,以便能够保证在应急事件发生后6小时内将应急物资运至省内各处。同时,进一步提出了河北省应急物资仓储管理对策,旨在应急灾害发生时能够全面保障河北省的应急物资管理需求。

基于医疗失效模式与效应分析优化急诊抢救室心电监护仪报警应答管理流程的研究

目的 探讨医疗失效模式与效应分析(health failure mode and effect analysis, HFMEA)在急诊抢救室心电监护仪报警应答管理流程中的应用效果。方法 将2023年7月-9月急诊抢救室收治的48例患者设为对照组,将2023年10月—12月急诊抢救室收治的48例患者设为观察组,对照组采用常规流程对心电监护仪报警进行应答管理,观察组采用基于HFMEA优化后的流程对心电监护仪报警进行应答管理。比较2组心电监护仪误报警率、报警应答有效率以及护士报警疲劳评分。结果 观察组心电监护仪误报警率低于对照组(χ2=156.225,P<0.001),报警应答有效率高于对照组(χ2=81.823,P<0.001),且实施HFMEA后急诊抢救室护士报警疲劳得分低于实施前(t=5.093,P<0.001)。结论 应用HFMEA对急诊抢救室监护仪报警应答管理流程进行优化,降低了心电监护仪误报警率,提高了报警应答有效率,减轻了护士的报警疲劳,从而有效防范因监护仪报警应答管理缺陷而导致的医疗风险。

基于信息化平台的急诊危重症患者护理核查单的设计及应用

目的探讨基于信息化平台的急诊危重症患者护理核查单的设计及应用效果。方法基于院内信息化平台,设计急诊危重症患者护理核查单。采用前瞻性类实验性研究方法,观察危重症患者护理核查单应用前后护理交接班的遗漏率、临床护理效果和护理质量。结果应用急诊危重症患者护理核查单后,护士在管路、通气方式、留置针、用药、皮肤和约束方面的交接班遗漏率显著低于应用前(均P<0.05);临床护理效果和护理质量较核查单应用前显著提升(均P<0.05)。结论基于信息化平台的急诊危重症患者护理核查单的应用可减少护士交接班的遗漏内容,提高护理记录准确性,并缩短书写时长,提高护理质量。

面向新工科的计算机专业与思政融合教学模式探索

随着新工科发展的逐步深化,为响应信息化、数字化转型需求,造就德才兼备的高素质应用型人才是计算机专业建设的重要使命。文章结合内蒙古科技大学计算机专业的特点探索专业建设与思政融合的教学模式,在新工科“专业课程+”中开展思政融合的“一体贯穿”教学模式,力求通过融合培养方式满足新工科人才在素养塑造及专业能力达成方面的需求。

“新工科”背景下建筑设计人才“3+3+3”培养模式的建构

“新工科”国家战略的推动下,我国高等院校建筑人才培养面临新的挑战,建筑设计人才培养体系、培养质量与“新工科”建设愿景仍存在差距。该研究借鉴新加坡高等教育发展历程以及新加坡国立大学建筑设计人才培养内涵,探析如何在“新工科”背景下推动建筑设计人才培养模式的建构,以培养主体、培养途径、培养层级三要素为建筑设计人才培养框架,创新性提出“3+3+3”多层级建筑人才培养模式,以期为“新工科”战略的实施提供高素质建筑设计人才保障。

线上线下混合式教学模式在急诊医学教学中的应用

目的探讨线上线下混合式教学模式在急诊医学教学中的应用效果。方法选取2020年2月至2021年7月温州医科大学第一临床医学院2017级(n=65)和2016级(n=67)“5+3”一体化临床医学专业学生为研究对象,2017级学生采用线上线下混合式教学模式,2016级学生采用传统教学模式,课程结束后对学生进行专业测试和问卷调查,以评价教学效果。结果2017级学生案例分析测试成绩为(17.44±4.19)分,高于2016级的(15.74±3.09)分,差异有统计学意义(P<0.05)。问卷调查显示2017级大多数学生赞同线上线下混合式教学模式,满意度较高。结论线上线下混合式教学模式得到了学生普遍认可,有助于调动学习积极性,培养学生分析和解决问题的能力,使学生建立临床思维,取得了良好的教学效果。

早期损伤控制复苏联合多学科协作急救模式对血流动力学不稳定型骨盆骨折病人疗效的影响

目的:探讨多学科协作急救模式联合早期损伤控制复苏治疗血流动力学不稳定型骨盆骨折的疗效。方法:选取实施多学科协作急救模式联合早期损伤控制复苏的血流动力学不稳定型骨盆骨折病人30例作为观察组,并选取观察组模式实施前行传统积极液体复苏的血流动力学不稳定型骨盆骨折病人30例作为对照组。统计分析2组病人24 h内胶体液、晶体液、血浆和浓缩红细胞的输注量,体温恢复、凝血功能恢复及乳酸清除时间,弥散性血管内凝血(DIC)发生率及死亡率。结果:观察组无胶体液补充。观察组病人晶体液和浓缩红细胞输注量均低于对照组,而血浆输注量高于对照组,体温恢复、凝血功能恢复及乳酸清除时间均短于对照组,差异均有统计意义(P<0.01);研究组DIC发生率为3.33%,死亡率为6.67%与对照组的10.00%和16.67%,差异均无统计意义(P>0.05)。结论:多学科协作急救模式联合早期损伤控制复苏应用于血流动力学不稳定型骨盆骨折,能够快速、有效地恢复病人血流动力学稳定状态。

苏州院前急救模式的实践与思考

目的探索和完善苏州院前急救模式。方法比较苏州周边地市院前急救模式,基于苏州院前急救模式建设概况、初步成效、现存问题进行探讨。结果苏州院前急救模式建设成效明显,但仍存在接听能力不足、未实现电话定位、直属力量薄弱、信息互通不全等问题。结论院前急救“苏州模式”可从提升接听能力、实现电话定位、增强直属力量、强化大市质控入手,全面提升苏州市院前急救的服务能级和保障能力,探索“苏州模式”更优发展。