新医改背景下提高急诊综合救治能力建设的探索与成效  

The exploration and effect on improving the capacity of emergency treatment under the background of healthcare reform

作　　者：冒山林[1] 夏志洁[1] 曹隽[1] 郭涛[1] 葛梓[1] 赵晖[1] 周鑫健[1] MAO Shanlin XlA Zhijie CAO Jun GUO Tao.GE Zi ZHAO Hui ZHOU Xinjian(Shanghai Fudan University Affiliated Huashan North Hospital. No.108, Luxiang Road, Baoshan District, Shanghai, 201907, PRC)

机构地区：[1]复旦大学附属华山医院北院

出　　处：《中国医院》2017年第1期8-11,共4页Chinese Hospitals

基　　金：上海市科委科技支撑计划医学重点项目(16411954400);上海市卫生和计划生育委员会面上项目(201640181);上海申康医院发展中心临床管理优化项目(SHDC20136012);上海市医院协会项目(2014010)

摘　　要：目的:评估新医改背景下复旦大学附属华山医院北院急诊综合救治能力建设的成效。方法:通过创新患者管理制度、规范就诊流程和培养医护人员急救能力等方法强化对急诊综合救治能力建设。以急诊专业医疗质量控制指标(2015版)对急诊综合救治能力进行效果评价。结果:随着急诊患者逐年增加,同期急诊医患比、医护比和患者滞留急诊时间有所下降。与2013年度比较,2015年度急诊STEMI患者平均门球时间明显降低,ROSC成功率显著提高。与2014年度比较,2015年度急危重症患者死亡率显著下降。至2015年底约2/3的急诊医师能独自完成急救操作技能,临床中所有急救工作均由急诊医师团队完成。结论:规范急诊患者管理流程和加强医护人员能力培养能显著提升急诊综合救治能力,提高对急危重症患者的处理水平。Objectives： To evaluate the effectiveness of improving the comprehensive capacity of rescuing patients under the background of healthcare reform. Methods： The comprehensive emergency capacity were improved by innovating patient management system, standardizing the treatment process and training emergency medical staff. Emergency medical quality control index. Edition 2015, was used to evaluate the comprehensive rescuing ability. Results： With the increasing in amount of emergency patients year by year, the ratio of emergency doctor-patient, the ratio of nurses-doctors and the staying time at emergency department were decreased compared with year on year. Compared with that in 2013, the average gate-ball time of acute ST segment elevation myocardial infarction（STEMI） patients was significantly reduced and the success rate of restoration of spontaneous circulation（ROSC） was increased significantly in 2015. Compared with that in 2014, the mortality of critically ill patients was decreased significantly in 2015. By the end of 2015 about two-thirds of the emergency physician can complete the emergency skills alone, and all emergency treatment were completed by emergency physician team. Conclusion： Standardizing the management processes of emergency patients and strengthening emergency doctors and nurses＇ training can significantly improve the comprehensive rescuing capacity in emergency department, and improve the level of treating patients with acute critical illness.

关 键 词：急诊医学 综合救治能力 急救能力 分级分诊 重点疾病 

分 类 号：R616.2[医药卫生—外科学]