重症体外膜肺氧合患者院际转运风险管理  

Risk management of inter-hospital transfer in patients with severe extracorporeal membrane oxygenation

作　　者：潘旗开[1] 刘延锦[1] 柴宇霞[1] 赵亚缓 雷蕾[1] 贾亚南 徐艳[2] PAN Qikai;LIU Yanjin;CHAI Yuxia;ZHAO Yati;LEI Lei;JIA Yanan;XU Yan(Emergency intensive care unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China)

机构地区：[1]郑州大学第一附属医院,河南郑州450052 [2]河南省人民医院,河南郑州450052

出　　处：《中国急救复苏与灾害医学杂志》2020年第1期20-25,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：国家临床重点专科建设项目(编号:2011872)。

摘　　要：目的探讨重症患者体外膜肺氧合(extracorporeal membrane oxygenation,EMCO)院际转运风险管理。方法回顾性分析2012年6月-2017年7月共有116例EMCO院际转诊,收集到98例临床资料(84.5%)的性别等基本资料,转运时长、转运距离、18.00-08.00点到达(%)、转运人员级别合格率(%)等转运特点资料,转运病种以及不良事件发生例数(包含与患者相关(P-AEs)和与转运设备或人员相关(E-AEs)两大类)进行统计学分析等。结果院际转运患者中(88人)来自省内18家协作医院;剩余(10人)来自省外4家ICU。3家ICU转运10例以上患者;5家ICU转运5~9例;其他ICU转运1~4例。超过1/3院际转运发生在夜晚(即18.00到08.00之间)到达;患者转运评估风险级别与转运人员等级相匹配合格率达90%;转运病种以重症肺炎为主,98次转运中只有5次发生不良事件(5.1%),但不良事件发生总例数为13例(13.2%)发生时间段主要分布在前期2013-2015年期间。与患者相关转运不良事件发生6例(6.1%)与转运设备或人员相关转运不良事件发生7例(7.1%),其中通信事件发生2例(2.0%),1例为转运时间计划不合理,1例为患者病情沟通出现差错。危险交通状况发生1例(1.0%)为司机疲劳驾驶等。结论构建区域性EMCO重症患者院际转运风险管理预警机制,形成以郑州大学第一附属医院体外支持团队为中心,重症患者院际转运中心为平台,EMCO重症患者院际转运小组为移动ECMO小组,集急救、转运、通讯、联络和培训为一体化向地区协作医院线性辐射的“中心-辐射”型EMCO重症患者医疗体系,明显降低EMCO重症患者院际转运不良事件发生率,保证EMCO院际转运患者安全与成功。同时,在降低医疗成本、医疗资源、患者并发症以及最重要的是提升ECMO院际转运质量等方面获得最大收益。Objective To explore the risk management of extracorporeal membrane oxygenation(EMCO)for inter-hospital transfer in critically ill patients.Methods A retrospective analysis of 116 cases of EMCO inter-hospital transfer from the First Affiliated Hospital of Zhengzhou University from June 2012 to July 2017.Basic data such as gender,98 patients,clinical data(84.5%)were collected.Data on transfer characteristics such as the qualification rate of transfer personnel,statistical analysis of transfer disease types and adverse events(including two categories of patient-related(P-AEs)and transfer equipment or personnel-related(E-AEs)).Results Among the inter-hospital transfer patients(88 people)came from 18 cooperative hospitals in the province;the remaining(10 people)came from 4 ICUs outside of the province.Three ICUs transferred more than 10 patients;5 ICUs transferred 5 to 9 cases;other ICUs transferred 1 to 4 cases.More than 1/3 of the inter-hospital transfers arrived at night(between 18.00 and 08.00);the patient's transfer assessment risk level matched the transfer personnel's grade and the eligibility rate reached 90%;the transfer disease was mainly pneumonia,and 98 transfers There were only 5 adverse events(5.1%),but the total number of adverse events was 13(13.2%).The lime period was mainly distributed in the previous period from 2013 to 2015.There were 6(6.1%)adverse events related to patient transfer and 7(7.1%)adverse events related to transfer equipment or personnel,of which 2(2.0%)were communication events,and 1 was an unreasonable transfer schedule.One case was an error in communication of the patient's condition.One case(1.0%)of a dangerous traffic situation occurred when the driver was fatigued.Conclusion The risk management mechanism for inler-hospilal transport of patients with EMCO was established,and form a support team for the Center Court in vitro,patients with severe Intercollegiate transit center as a platform,inter-hospital transport of critically ill patients EMCO group for mobile ECMO team,set fir

关 键 词：体外膜肺氧合 院际转运 重症患者 风险管理 

分 类 号：R47[医药卫生—护理学]