危重症患儿院际转运实践方案的构建

doi:10.3761/j.issn.0254-1769.2023.22.001

摘要/Abstract

摘要：

目的构建基于循证、本土化的危重症患儿院际转运实践方案。方法通过证据总结和半结构式访谈，初步形成危重症患儿院际转运实践方案。遴选国内12所医院的31名专家，于2022年5月—7月进行2轮专家函询，对方案条目进行修订。结果 2轮专家函询的问卷回收率均为100%，专家的权威系数为0.926~0.931。第2轮函询中，各条目重要性评分的变异系数为0.036~0.226，肯德尔和谐系数为0.201（P<0.001）；各条目可行性评分的变异系数为0.070~0.314，肯德尔和谐系数为0.124（P<0.001）。最终形成危重症患儿院际转运实践方案包括8项一级条目、16项二级条目、75项三级条目。结论该研究构建的危重症患儿院际转运实践方案具有较好的科学性和可操作性，可为危重症患儿院际转运的组织和实施提供参考。

关键词: 危重病, 院际转运, 德尔菲技术, 儿科护理学

Abstract:

Objective To develop an evidence-based，localized practice protocol for the interhospital transfer of critically ill children. Methods Through a comprehensive evidence summary and semi-structured interviews，a preliminary inter-hospital transfer practice protocol for critically ill children was formulated. A panel of 31 experts from 12 hospitals in China participated in 2 rounds of expert correspondence between May and July 2022，facilitating meticulous revision of the protocol entries. Results The response rate for both rounds of questionnaires was 100%，and the expert authority coefficients ranged from 0.926 to 0.931. In the second round of consultation，the coefficient of variation for the importance score of each entry ranged from 0.036 to 0.226，and the Kendall’s W was determined to be 0.201（P<0.001）. Additionally，the coefficient of variation for the feasibility score of each entry fell within the range of 0.070 to 0.314，with Kendall’s W of 0.124（P<0.001）. Ultimately，the final interhospital transfer protocol for critically ill children comprised 8 level Ⅰ entries，16 level Ⅱ entries，and 75 level Ⅲ entries. Conclusion The interhospital transfer protocol constructed in this study is grounded in scientific evidence and exhibits practical feasibility. It serves as a valuable reference for organizing and implementing interhospital transfers of critically ill children.

Key words: Critical Illness, Inter-Hospital Transfer, Delphi Technique, Pediatric Nursing

王蓓蓓, 顾莺, 胡静, 陆国平, 程晔, 沈伟杰, 陈伟明, 李阳. 危重症患儿院际转运实践方案的构建[J]. 中华护理杂志, 2023, 58(22): 2693-2701.

WANG Beibei, GU Ying, HU Jing, LU Guoping, CHENG Ye, SHEN Weijie, CHEN Weiming, LI Yang. Construction of a practical program for interhospital transfer of critically ill children[J]. Chinese Journal of Nursing, 2023, 58(22): 2693-2701.

图/表 1

参考文献 21

[1]	Kiss T, Bölke A, Spieth PM. Interhospital transfer of critically ill patients[J]. Minerva Anestesiol, 2017, 83(10):1101-1108. DOI PMID
[2]	Kawaguchi A, Saunders LD, Yasui Y, et al. Effects of medical transport on outcomes in children requiring intensive care[J]. J Intensive Care Med, 2020, 35(9):889-895. DOI PMID
[3]	Kulshrestha A, Singh J. Inter-hospital and intra-hospital patient transfer:recent concepts[J]. Indian J Anaesth, 2016, 60(7):451-457. DOI PMID
[4]	胥志跃, 肖政辉, 仇君, 等. 湖南省儿童医院院际转诊危重患儿不良事件分析[J]. 中国小儿急救医学, 2016, 23(5):329-332.
	Xu ZY, Xiao ZH, Qiu J, et al. Adverse events of inter-hospital transport of critical pediatric patient in Hunan children’s hospital[J]. Chin Pediatr Emerg Med, 2016, 23(5):329-332.
[5]	中华医学会急诊医学分会儿科学组, 中华医学会儿科学分会急救学组,中国医师协会儿童重症医师分会. 重症儿童院际三级转诊专家建议[J]. 中华儿科杂志, 2015, 53(8):573-575.
	Chinese Medical Association, Emergency Medicine Branch,Pediatrics Group,Chinese Medical Association,Pediatrics Branch,Emergency Medicine Group,Chinese Medical Doctor Association,Pediatric Intensive Care Physicians Branch. Expert recommendations for the inter-hospital tertiary referral of critically ill children[J]. Chin J Pediatr, 2015, 53(8):573-575.
[6]	Advanced Life Support Group. Neonatal,adult and paediatric safe transfer and retrieval a practical approach to transfers[M]. Chichester: John Wiley & Sons Ltd, 2019.
[7]	王蓓蓓, 顾莺, 胡静, 等. 危重症儿童院际转运组织与实施的证据总结[J]. 中国护理管理, 2022, 22(11):1669-1675.
	Wang BB, Gu Y, Hu J, et al. Evidence summary for inter-hospital transport of critically ill children[J]. Chin Nurs Manag, 2022, 22(11):1669-1675.
[8]	Carayon P, Wooldridge A, Hoonakker P, et al. SEIPS 3.0:human-centered design of the patient journey for patient safety[J]. Appl Ergon, 2020, 84:103033. DOI URL
[9]	曾光. 现代流行病学方法与应用[M]. 北京: 北京医科大学、中国协和医科大学联合出版社,1994.
	Zeng G. Modern epidemiological methods and applications[M]. Beijing: Beijing Medical University & China Union Medical University Press,1994.
[10]	刘盎, 孟倩倩, 张洪磊, 等. 急诊危重患者院内转运质量评价指标的构建[J]. 中华护理杂志, 2021, 56(3):336-341. DOI
	Liu A, Meng QQ, Zhang HL, et al. Construction of a quality evaluation index for intra-hospital transport of emergency critically ill patients[J]. Chin J Nurs, 2021, 56(3):336-341. DOI
[11]	李洪兴, 罗庆, 张荣, 等. 肯德尔和谐系数W检验及程序实现[J]. 中国医院统计, 2013, 20(3):170-173.
	Li HX, Luo Q, Zhang R, et al. Test of Kendall coefficient of concordance W and the implementation of programs[J]. Chin J Hosp Stat, 2013, 20(3):170-173.
[12]	李凡, 孙朋霞, 李树亚, 等. 急诊危重症患者院间转运现状的横断面调查研究[J]. 中国急救医学, 2022, 42(2):132-136.
	Li F, Sun PX, Li SY, et al. A cross-sectional survey of the current status of interhospital transfer for critically ill patients[J]. Chin J Crit Care Med, 2022, 42(2):132-136.
[13]	祝益民. “重症儿童院际三级转诊专家建议”解读[J]. 中华儿科杂志, 2015, 53(8):581-583.
	Zhu YM. Interpretation of “expert suggestions for three-level inter-hospital referral of severe children”[J]. Chin J Pediatr, 2015, 53(8):581-583.
[14]	American Academy of Pediatrics. Guidelines for air and ground transport of neonatal and pediatriс patients[M]. 4th ed. Phila-delphia: American Academy of Pediatrics, 2016.
[15]	梁江淑渊, 曾妃, 黄冰瑛, 等. 体外膜肺氧合支持下患者院内转运安全管理的最佳证据总结[J]. 中华护理杂志, 2022, 57(12):1456-1461. DOI
	Liang JSY, Zeng F, Huang BY, et al. Evidence summary of safety management of intra-hospital transport in patients on extracorporeal membrane oxygenation[J]. Chin J Nurs, 2022, 57(12):1456-1461. DOI
[16]	Mueller SK, Shannon E, Dalal A, et al. Patient and physician experience with interhospital transfer:a qualitative study[J]. J Patient Saf, 2021, 17(8):e752-e757. DOI URL
[17]	Warren J, Fromm RE Jr, Orr RA, et al. Guidelines for the inter-and intrahospital transport of critically ill patients[J]. Crit Care Med, 2004, 32(1):256-262. DOI URL
[18]	Qiu J, Wu XL, Xiao ZH, et al. Investigation of the status of interhospital transport of critically ill pediatric patients[J]. World J Pediatr, 2015, 11(1):67-73. DOI PMID
[19]	朱艳娟, 洪小杨, 赵喆, 等. 危重症患儿体外膜肺氧合支持下长途转运的护理[J]. 中华护理杂志, 2021, 56(4):581-584. DOI
	Zhu YJ, Hong XY, Zhao Z, et al. The nursing care of domestic long-distance transport in critically ill children supported by ECMO[J]. Chin J Nurs, 2021, 56(4):581-584. DOI
[20]	刘学英, 黄丽华, 邹翼霜, 等. 转运核查单的编制及在院内危重患者转运中的应用[J]. 中华护理杂志, 2016, 51(12):1469-1473.
	Liu XY, Huang LH, Zhou YS, et al. The impact of intra-hospital transport checklist on transport safety of critically ill patients[J]. Chin J Nurs, 2016, 51(12):1469-1473.
[21]	马莉, 王志稳, 葛宝兰, 等. 急诊科危重患者院内转运前核查单的编制及应用[J]. 中华急危重症护理杂志, 2020, 1(1):37-44.
	Ma L, Wang ZW, Ge BL, et al. The development of intra-hospital transport checklist for critically ill patients in emergency department[J]. Chin J Emerg Crit Care Nurs, 2020, 1(1):37-44.