限制抢救室人流量对急诊医疗质量的影响  

Effect of limitation in flow of people on medical care quality in emergency resuscitation room

作　　者：许士海[1] 管穗丽 谢曼英[1] 林慧绒[1] 史菲[1] 王进[1] 单爱军[1] Xu Shihai;Guan Suili;Xie Manying;Lin Huirong;Shi Fei;Wang Jin;Shan Aijun(Emergency Center, Shenzhen People ＂s Hospital, the Second Medical College of Jinan University, Shenzhen 518020, China)

机构地区：[1]暨南大学第二临床医学院深圳市人民医院急诊中心,深圳518020

出　　处：《中华急诊医学杂志》2018年第7期815-820,共6页Chinese Journal of Emergency Medicine

基　　金：深圳市卫计委科研项目（201607011）;深圳市卫计委科研项目（201601013）;深圳市科技计划项目（JCYJ20160422152608675）

摘　　要：目的 探讨限制抢救室人流量对急诊医疗质量的影响。方法 采用回顾性前后对照研究，对比限制人流量前后（2015 年10-12 月与 2016 年2-4 月）的抢救室噪音、医护职业暴露、不良事件、院感率、滞留时间、死亡、CPR 后ROSC 和非计划重返率、STEMI 的门药和门球时间 及医护患满意度。计量及计数资料比较分别采用成组t 检验和χ2 检验，医护职业暴露与不良事件比较采用泊松Z 检验。结果 限制人流量前后分别收治患者5 031 例和5 097 例。两时段病例诊断与病情严重度相当（P〉0.05）。限制人流量后，抢救室噪音下降（P〈0.01）；医护职业暴露（14 例vs. 4 例，Z=2.357，P=0.018）和不良事件（18 例 vs. 5 例，Z=2.711，P=0.007）减少；院感率下降（1.1% vs. 0.5%，χ2=8.111，P=0.004）；滞留时间缩短[（6.3±0.8） h vs.（ 4.6±0.6） h，t=121.083，P〈0.01] ；门球时间下降[（91.2±12.8） min vs.（ 89.3±8.0） min，t=2.486，P=0.013] ；患者及医护满意度改善。两阶段死亡、CPR 后ROSC 和非计划重返率及门药时间差异无统计学意义。结 论 限制抢救室人流量能降低噪音，减轻医护人员压力，提升工作效率，减少医疗差错，提升医务和患者满意度。Objective To investigate the effect of limitation in flow of people on medical care quality in emergency resuscitation room （ERR）. Methods This study was retrospectively performed to compare emergency medical quality before and after （October to December, 2015 vs. February to April, 2016） limitation of flow of people in ERR. Variables included noise level, occupational exposure, adverse event, hospital-acquired infection, length of stay （LOS） in ERR, mortality rate, return of spontaneous circulation （ROSC） rate after cardiopulmonary resuscitation （CPR）, the rate of unexpected return to ERR, door to drug and door to balloon time for patients with ST-segment elevated myocardial infarction （STEMI）, patients＇ and emergency personnels＇ satisfaction level. The data were analyzed with t-test, chi-square test or Poisson Z test where appropriate. Results There were 5 031 and 5 097 patients respectively admitted in ERR before and after limitation of flow of people. Patients＇ main diagnoses and severity of illness between the two periods had no significantly difference （P〉0.05）. After the limitation of flow of people, the noise level in ERR was lowered （P〈0.01）, the numbers of occupational exposure events （14 cases vs. 4 cases, Z=2.357, P=0.018） and adverse events （18 cases vs. 5 cases, Z=2.711, P=0.007） were decreased, the rate of hospital-acquired infection was reduced （1.1% vs. 0.5%, χ2=8.111, P=0.004）, the LOS in ERR was shortened [（6.3±0.8） h vs. （4.6±0.6） h, t=121.083, P〈0.01], the door to balloon time for STEMI patients was also decreased [（91.2±12.8） min vs. （89.3±8.0） min, t=2.486, P=0.013]. Moreover, patients＇ and emergency personnels＇ satisfaction level were elevated. No significant difference was observed in mortality rate, ROSC rate, rate of unexpected return to ERR and door to drug time for STEMI patients. Conclusions The limitation of flow of people in ERR can lower the noise level, reduce emergency personnels＇ working pressure

关 键 词：抢救室 人流量 医疗质量 院感 病死率 绿色通道 满意度 

分 类 号：R459.7[医药卫生—急诊医学]