目的 探讨无缝隙护理管理在重症急性脑血管病患者急救转运中的应用。方法 本研究回顾性分析了2017年郑州大学第二附属医院转运的52例重症急性脑血管病患者,实施无缝隙化转运管理后的效果,对照组为2016年22例常规转运患者,分析其抢救成功率和满意度。结果 2组患者均成功实现院间转运,和对照组相比,实施无缝化转运管理后,院外转运时间明显缩短,意外事件发生率明显降低,患者满意度提高。结论 重症急性脑血管病患者院间急救转运中,实施无缝隙护理管理具有较高转运效率和安全性。
无缝隙护理管理对重症急性脑血管病患者院间转运的影响
孙甜甜 张 丽△ 李付华 张 苇
郑州大学第二附属医院,河南郑州 450014
作者简介:孙甜甜,Email:523410416@qq.com
△通信作者:张丽,Email:anran6699@126.com
【摘要】 目的 探讨无缝隙护理管理在重症急性脑血管病患者急救转运中的应用。方法 本研究回顾性分析了2017年郑州大学第二附属医院转运的52例重症急性脑血管病患者,实施无缝隙化转运管理后的效果,对照组为2016年22例常规转运患者,分析其抢救成功率和满意度。结果 2组患者均成功实现院间转运,和对照组相比,实施无缝化转运管理后,院外转运时间明显缩短,意外事件发生率明显降低,患者满意度提高。结论 重症急性脑血管病患者院间急救转运中,实施无缝隙护理管理具有较高转运效率和安全性。
【关键词】 急性脑血管病;无缝隙护理管理;急救;转运;老年
【中图分类号】 R473.74 【文献标识码】 A 【文章编号】 1673-5110(2018)24-2772-04 DOI:10.12083/SYSJ.2018.24.576
Effect of seamless care management on inter-hospital transport of severe acute cerebrovascular disease
SUN Tiantian,ZHANG Li,LI Fuhua,ZHANG Wei
The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450014,China
【Abstract】 Objective To explore the application of seamless nursing management in emergency rescue of severe acute cerebrovascular disease.Methods This study retrospectively analyzed the effects of seamless translocation management in 52 patients with severe acute cerebrovascular disease who were transported in the Second Affiliated Hospital of Zhengzhou University in 2017.The control group was 22 patients with routine transfusion in 2016.Rescue success rate and satisfaction were analyzed.Results Both groups of patients successfully achieved inter-hospital transport.Compared with the control group,after the implementation of seamless transport management,the out-of-hospital transit time was significantly shortened,the incidence of accidents was significantly reduced,and patient satisfaction was improved.Conclusion In the inter-provincial emergency transport of patients with severe acute cerebrovascular disease,the implementation of seamless care management has higher transport efficiency and safety.
【Key words】 Acute cerebrovascular disease;Seamless care management;First aid;Transport;Elderly
急性脑血管病是老年患者中的多发病、常见病。由于此病起病急、病情进展快、病死率高,治疗窗口期在6 h以内,需要在发病早期及时治疗,以避免或减轻后遗症和并发症[1-4],因此也对患者及时转运提出了更高要求。无缝隙护理管理以科学管理理念优化业务流程,合理配置人力和物力,保证诊疗连贯性[5-8]。本研究对郑州大学第二附属医院脑血管病患者的转运过程中的各项护理措施进行总结,探讨无缝隙护理管理模式的影响。
1 资料与方法
1.1 临床资料 本研究纳入2016—2017年74例重症急性脑血管病患者52例为2017年优化和改善转运流程后患者,对照组22例为2016年院间转运患者。
1.2 护理方法
1.2.1 转运小组建立和转运制度制定:①优化转运小组。转运小组在急救小组基础上,进行优化组合。由重症医学科高级职称医师担任组长,护士长任副组长,统筹规划;转运小组人员2名医师和2名护士组成,其中高级职称医师1名、重症专科护士1名(工作年限应在5 a以上)。②建立和完善急救转运和交接制度。制定无缝隙化护理管理程序,建立院前急救措施、转运、院内接收标准化制度;利用好院内重症患者救治绿色通道,做到事先联系、随时接诊和及时救治。③定期培训。由转运小组成员进行演练,确保相关工作人员熟练掌握转运、接收流程,定期进行培训和考核。
1.2.2 转运条件准备:接诊医护人员应详细询问患者病情,安排人员立即组成急性脑血管病院前转运小组。转运小组要综合考虑路线、天气、通讯等条件,准备转运设备和药品[9-12]。
1.2.3 患者准备:转运患者前要进一步了解患者病情,内容包括病史、体格检查、对病情做出初步判断,判定患者是否适合转运及讨论转运过程中需要注意的问题。同时在转运过程中患者还需注意:①要保持呼吸道通畅;②建立静脉通道;③控制脑水肿降低颅内压;④控制血压[13-16]。
1.2.4 转运过程监测:转运过程中要密切监测患者生命体征,包括血压、心率、呼吸、血氧饱和度等,注意颅内压升高和中枢性呼吸衰竭等并发症的处理。对清醒的患者,转运途中护士配合医师进行必要的心理护理[17-20],及时发现问题,对随车家属,也做好病情交代,进行心理指导。
1.2.5 启动院内急救转运通道:到达本院前,通知院内救护小组到位,患者入科和住院手续办理同步进行。事先联系影像科专职技师(以CT和磁共振为主),做到入院即可直接进行影像学检查,及时了解病情变化。
1.3 评价指标 (1)转运时间:包括外院停留时间和本院接收时间,按照转运记录时间进行统计。(2)并发症:主要包括生命体征、意识、其它神经系统症状或体征、心肺功能出现异常波动等;(3)意外事件:主要包括转运过程中出现的非医疗时间,如堵车、工作人员不到位等造成的延误、车辆或仪器的故障等。(4)患者满意度:包括对患者转运的效率、患者转运期间病情控制、对话和服务态度、患者贵重物品交接等进行打分。计分标准为“满意”、“较满意”、“不满意”。
1.4 统计学方法 数据用SPSS 21.0处理,P<0.05为差异有统计学意义。
2 结果
本研究22例采用常规急救转运流程,52例实施无缝隙化护理管理模式,患者均顺利入住ICU继续治疗。性别、年龄、转运距离在2组间差异无统计学意义(P>0.05),具有可比性。见表1。
根据无缝隙管理进行院间转运流程优化和改进后,转运效率大大提高,外院滞留时间较对照组明显缩短,意外事件发生率也明显降低;患者满意度也明显提升(表2)。尽管采用无缝隙管理前后,本院接收时间无明显差异,但时间仍有减少趋势;同样,转运过程中的并发症发生率也有所降低。
表1 2组患者一般资料比较
Table 1 Comparison of general data of 2 groups of patients
资料 |
对照组 |
优化组 |
χ2/t值 |
P值 |
性别 男 |
13 |
34 |
0.264 |
0.61 |
女 |
9 |
18 |
|
|
年龄/岁 |
69.55±7.93 |
68.83±11.82 |
1.017 |
0.31 |
转运距离 |
192.63±47.84 |
170.35±77.98 |
0.84 |
0.40 |
表2 无缝隙管理对转运效果的影响
Table 2 Effect of seamless management on transport efficiency
项目 |
对照组 |
优化转运组 |
χ2/t值 |
P值 |
外院滞留时间(h)* |
44.36±15 |
34.02±9.70 |
4.507 |
0 |
本院接收时间(h)** |
27.27±6.19 |
23.63±7.22 |
2.063 |
0.04 |
并发症发生率 |
27.27(6/22) |
9.62(5/52) |
3.809 |
0.05 |
意外事件发生率 |
22.73(5/22) |
3.85(2/52) |
6.435 |
0.01 |
满意度调查 满意 |
27.27(6/22) |
61.54(32/52) |
7.37 |
0.03 |
较满意 |
36.36(8/22) |
21.15(11/52) |
|
|
不满意 |
36.36(8/22) |
17.31(9/52) |
|
|
注:*到达外院时间至接收患者后开始出发的时间;**到达本院后至完成入院医护交接时间
3 讨论
急性脑血管病是常见急危重症,需要及时的诊断和治疗,部分患者可出现后遗症,影响患者的生活质量[21-25]。急性脑血管意外如果发病6 h以内就得到诊断和治疗,可明显提高救治的成功率[26-27]。
部分患者可以在基层医院得到满意诊疗,但由于医疗条件所限,也有部分患者在当地医院未能明确病因或明确诊断,需要院间转运到上级医院进一步诊治。患者转运过程也存在一定的风险[28],因此,保障转运效果,维持患者生命安全,有效转运是进一步救治的基础[29-30]。
无缝隙护理管理是美国湖地医疗中心1989年推出的管理概念。通过标准化的救治和转运流程,做到提前培训、良好的准备、患者评估、转运过程中的标准化操作、绿色通道的保障等,明显提高了转运成功率,保障了患者安全转运,提高了患者后期的治疗效果[31-32]。
通过转运患者的回顾性分析,发现采用无缝隙转运流程后,患者均成功从外院转运到我院。由于有了各种优化的流程和意外事件的培训,转运途中的出现的病情变化情况,均得到有效快速的处理,未发生患者死亡事件。分析发现,改进和优化转运流程后,接收患者时外院停留时间、转运途中的意外事件明显减少,患者满意度明显提升。尽管无统计学差异,但院内接收时间、并发症的发生率也得到改善。
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(收稿2018-10-20 修回2018-11-26)
本文责编:夏保军
本文引用信息:孙甜甜,张丽,李付华,张苇.无缝隙护理管理对重症急性脑血管病患者院间转运的影响[J].中国实用神经疾病杂志,2018,21(24):2772-2775.DOI:10.12083/SYSJ.2018.24.576
Reference information:SUN Tiantian,ZHANG Li,LI Fuhua,ZHANG Wei.Effect of seamless care management on inter-hospital transport of severe acute cerebrovascular disease[J].Chinese Journal of Practical Nervous Diseases,2018,21(24):2772-2775.DOI:10.12083/SYSJ.2018.24.576