JCI標(biāo)準(zhǔn)下院內(nèi)急救體系運(yùn)行及對(duì)急救時(shí)效性的影響

顏莉

【摘要】 目的：探討JCI標(biāo)準(zhǔn)下院內(nèi)一體化快速急救體系新模式對(duì)嚴(yán)重創(chuàng)傷患者急救時(shí)效性的影響。方法：將JCI標(biāo)準(zhǔn)下院內(nèi)一體化快速急救體系新模式啟動(dòng)前后的相同時(shí)間段內(nèi)（12個(gè)月）嚴(yán)重創(chuàng)傷急救患者分為對(duì)照組（88例）和觀察組（112例）。對(duì)照組實(shí)施院內(nèi)傳統(tǒng)急診救治、轉(zhuǎn)運(yùn)和交接，觀察組實(shí)施院前呼叫預(yù)警，院內(nèi)多學(xué)科多部門系統(tǒng)協(xié)同急救小組緊急干預(yù)、搶救和轉(zhuǎn)運(yùn)的一體化快速急救模式。回顧性分析對(duì)比兩組患者院內(nèi)急救時(shí)效性。結(jié)果：觀察組患者院內(nèi)急救過(guò)程中各階段的平均救治時(shí)間均明顯較對(duì)照組縮短（P<0.05）;觀察組救治成功率明顯高于對(duì)照組，觀察組院內(nèi)轉(zhuǎn)運(yùn)交接不良事件發(fā)生率、并發(fā)癥發(fā)生率和死亡率明顯低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論：JCI標(biāo)準(zhǔn)下院內(nèi)一體化快速急救體系新模式可顯著提高嚴(yán)重創(chuàng)傷患者急救工作時(shí)效性，提高搶救成功率，降低創(chuàng)傷并發(fā)癥發(fā)生率和死亡率，保證了患者醫(yī)療安全。

【關(guān)鍵詞】 JCI標(biāo)準(zhǔn);院內(nèi)急救;一體化;多學(xué)科;嚴(yán)重創(chuàng)傷;成功率

[Abstract] Objective：To explore the effect of the new model of integrated rapid first aid system in the lower court of JCI standard on the timeliness of emergency treatment for patients with severe trauma.Methods：The patients with severe trauma in the same time period （12 months） before and after the start of the new model of the integrated rapid emergency system in the JCI standard were divided into the control group （88 cases） and the observation group （112 cases）. The control group implemented traditional emergency treatment， transshipment and handover in the hospital， the observation group implemented pre-hospital call warning， and the integrated rapid emergency mode of emergency intervention， rescue and transshipment of the multidisciplinary multi-sector system synergy emergency team in the hospital. Retrospective analysis compared the timeliness of in-hospital first aid in both groups.Results：The average treatment time of the patients in the observation group was significantly shorter than that of the control group （P<0.05）. The success rate of the observation group was significantly higher than that of the control group. The incidence of adverse events and the incidence of complications in the observation group. The mortality rate was significantly lower than that of the control group， and the difference was statistically significant （P<0.05）.Conclusion：The new model of integrated rapid emergency system in the lower court of JCI standard can significantly improve the timeliness of emergency work for severely injured patients， improve the success rate of rescue， reduce the incidence of trauma complications and mortality， and ensure the medical safety of patients.

[Key words]JCI standard; Hospital first aid; Integration; Multidisciplinary; Severe trauma; Success rate

嚴(yán)重創(chuàng)傷患者急救效果和生命安全的救治意義取決于急診救治的時(shí)效性。我國(guó)傳統(tǒng)的急診救治受限于院前呼叫預(yù)警信息系統(tǒng)配置不完善，院內(nèi)急救人力資源配備不足，調(diào)配機(jī)制不合理等情況，嚴(yán)重影響嚴(yán)重創(chuàng)傷患者急救時(shí)效性[1]。自2011 年1月1日起，國(guó)際聯(lián)合委員會(huì)（JCI）要求通過(guò)國(guó)際醫(yī)院標(biāo)準(zhǔn)的醫(yī)院實(shí)施國(guó)際患者安全目標(biāo)（IPSG）。國(guó)際患者安全目標(biāo)的目的是促進(jìn)病人安全的具體改進(jìn)。這些目標(biāo)關(guān)注醫(yī)療照護(hù)中容易出問(wèn)題的領(lǐng)域，并提出以循證或?qū)＜夜沧R(shí)為基礎(chǔ)的解決方案，充分認(rèn)識(shí)到設(shè)計(jì)完善的系統(tǒng)是保障提供安全、高質(zhì)量醫(yī)療照護(hù)的關(guān)鍵[2-3]。2018年1月，本院參照J(rèn)CI標(biāo)準(zhǔn)，改造院內(nèi)急救流程，啟動(dòng)院內(nèi)一體化快速急救體系，包括成立院前院內(nèi)緊急呼叫HIS系統(tǒng)平臺(tái)、院內(nèi)多