EWS評分在急診留觀病人中的應(yīng)用研究

陳遠告 孟新科

[摘要] 目的 探討EWS評分在急診留觀病人風(fēng)險管理中的應(yīng)用價值。方法 通過動態(tài)監(jiān)測197例留觀病人EWS評分,決定病人處理策略和去向;比較不同流向病人評分的差異;調(diào)查醫(yī)生、護士對實施EWS評分管理模式的滿意度。 結(jié)果 評分無動態(tài)變化的156例病人EWS評分為2.1±1.3;有動態(tài)變化的41例中,直接收住院的30例病人評分為4.9±1.6;轉(zhuǎn)搶救室11例病人評分為6.1±2.2。各組病人評分比較差異均有統(tǒng)計學(xué)意義(2.1±1.3 VS 4.9±1.6,t=3.43P=0.002;2.1±1.3 VS 6.1±2.2,t=5.21P=0.000;4.9±1.6 VS 6.1±2.2,t=2.85P=0.009);醫(yī)生護士對實施EWS評分動態(tài)監(jiān)測以前后的留觀病人管理滿意度分別為75.5%和94.3%,前后比較差異有統(tǒng)計學(xué)意義(x²=7.36,P<0.01)。結(jié)論 EWS評分可作為急診留觀病人風(fēng)險管理和合理分流的有效工具,值得臨床推廣。

[關(guān)鍵詞] 改良早期預(yù)警評分;急診;觀察病房;管理

[中圖分類號] R259 [文獻標(biāo)識碼] A [文章編號] 1004-8650(2009)05-124-02

Application study on administering patients in emergency observation ward with early warning score

CHENYuan-gao1, MENG Xin-ke2

(1.Hengyang mother and children health care institute;2.The First affiliated hospital of Shenzhen university )

[Abstract] Objective To explore the application value of early warning score (EWS) on administration of patients in emergency observation ward. Methods Triage criteria of 197 emergency observation patients were determined by EWS and the scores were compared among different admission departments. Approving to “EWS administration model” was investigated on doctors and nurses in emergency departments. ResultsThere were significantly difference in EWS among different admission departments (2.1±1.3 for 156 of patients which had no change in EWS VS 4.9±1.6 for 30 of hospital admission patients which had elevated in EWS,t=3.43P=0.002;2.1±1.3 VS 6.1±2.2 for 11 emergency rescue room admission patients which had elevated in EWS t=5.21 P=0.000;4.9±1.6 VS 6.1±2.2,t=2.85P=0.009) and Approving to “EWS administration model” in doctors and nurses in emergency department. (75.5% for non “EWS administration model” VS 94.3% for “EWS administration model”, x2=7.36,P<0.01). Conclusion EWS may be popularized in emergency observation ward as a tool of risk administration on patients.

[Key words] early warning score; emergency; observation ward; administration

早期預(yù)警評分(early warning score, EWS)[1]是急診常用的潛在危險疾病評分方法,多用于急診病人的分流,如確定病人是否住院專科治療或接受ICU監(jiān)護治療;也可預(yù)測病人院內(nèi)死亡危險性。我們將其用于急診留觀病人的動態(tài)觀察和風(fēng)險管理,現(xiàn)將相關(guān)結(jié)果報告如下。

1資料與方法

1.1病例資料

選擇2009年1-4月本院急診科留觀的所有214例病人為研究對象,排除資料不全或因各種原因不配合醫(yī)生治療決策的病人,實際納入研究197例。其中男123例,女91例;年齡14-86歲,平均(43.3±31.9)歲;急診觀察室停留時間0.9–3.4天,平均(2.0±1.4)天。

1.2 方法

1.2.1研究方法所有病人在留觀前均需完善體溫、呼吸、脈搏、血壓、意識狀態(tài)、心電圖等檢查,進行EWS評分,2-4分者可以進入留觀室觀察治療,并由接診醫(yī)生書寫專門的急診觀察病歷,填寫EWS評分動態(tài)觀察表,護士按EWS評分級別分別進行動態(tài)監(jiān)測并記錄在觀察表上。……