急危重症患者院际转诊规范化管理流程的应用

doi:10.3761/j.issn.0254-1769.2020.12.006

摘要/Abstract

摘要：

目的评价急危重症患者院际转诊流程的应用效果,规范院际转诊工作。方法通过文献检索、专家会议、专家咨询,构建急危重症患者院际转诊流程及院际转诊交接核查表,并应用于临床2个月,观察其对院际转诊交接时长及院际转诊不良事件发生率的影响。结果临床应用后,转诊医院转诊前提前联系接诊医院的比率达到100%,院际转诊交接核查表填写完整率为96.15%,交接时间由（14.44±3.52） min降至（9.33±1.83） min,院际转运不良事件发生率由21.05%降低到3.85%,差异均有统计学意义（P<0.001,P=0.017）。结论该研究构建的急危重症患者院际转诊流程及院际转诊交接核查表有较好的科学性与实用性,规范了院际转诊工作,可提高院际转诊工作效率,降低院际转运不良事件发生率,保证患者转运安全。

关键词: 危重病, 院际转诊, 流程, 核查表, 患者交接, 护理管理研究

Abstract:

Objective To evaluate clinical application effects of standardized management of inter-hospital referral process. Methods The process of inter-hospital referral and the checklist of handover were formulated through literature reviews,expert discussions and consultations. The process and the checklist were adjusted by modified Delphi method,and were applied into the clinical practice for 2 months. The impact on the duration of inter-hospital referral and the incidence of adverse events was observed. Results After the clinical application,the rate of the communication between referral hospitals before the transferring has reached 100%;the completion rate of checklists was 96.15%;the length of time on handover fell from（14.44±3.52）mins to（9.33±1.83）mins;the incidence of adverse events decreased from 21.05% to 3.84%;the differences were statistically significant（P<0.01,P<0.05）. Conclusion The process and the checklist of inter-hospital referral are scientific and practical. They standardized the process,improved the work efficiency and reduced the incidence of adverse events,which can be applied to clinical practice and improve patient safety.

Key words: Critical Illness, Inter-Hospital Referral, Process, Checklist, Handover Patient, Nursing Administration Research

程俊亚,居俏艳,刘学英,曹伟中,陈子红,朱玲雅. 急危重症患者院际转诊规范化管理流程的应用[J]. 中华护理杂志, 2020, 55(12): 1791-1795.

CHENG Junya,JU Qiaoyan,LIU Xueying,CAO Weizhong,CHEN Zihong,ZHU Lingya. Development and clinical application of standardized management of inter-hospital referral in critically ill patients[J]. Chinese Journal of Nursing, 2020, 55(12): 1791-1795.

图/表 2

图1 急危重症患者院际转诊交接核查表（第1、2部分）注：T为体温,P为脉搏,R为呼吸,BP为血压,CPR为心肺复苏术,1 mmHg=0.133 kPa。

Figure 1 Checklist of handover in inter-hospital referral for critically ill patients（the first part and the second part）

图2 急危重症患者院际转诊交接核查表（第3部分）注：T为体温,P为脉搏,R为呼吸,BP为血压,CT为电子计算机断层扫描,MRI为磁共振成像;1 mmHg=0.133 kPa。

Figure 2 Checklist of handover in inter-hospital referral for critically ill patients（the third part）

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