重大传染病4级预检分诊标准的建立与实践  

Development and application of four-level triage system for major infectious Diseases

作　　者：李金林[1] 姜淮芜[1] 刘海燕[1] 刘冰[1] 陈慧[1] 韩爱华[1] 黄玉梅 万娴 Li Jinlin;Jiang Huaiwu;Liu Haiyan;Liu Bing;Chen Hui;Han Aihua;Huang Yumei;Wan Xian(Sichuan Mianyang 404 Hospital,Mianyang 621000,China)

机构地区：[1]四川绵阳四0四医院(川北医学院附属第二医院),四川省绵阳市621000

出　　处：《现代养生》2021年第14期146-150,共5页Health Protection and Promotion

基　　金：四川省教育厅人文社会科学重点研究基地—四川医院管理和发展研究中心资助科研项目(编号:SCYG2020-12);绵阳市科技局新型冠状病毒肺炎应急科研项目(编号:2020YJKY011,2020YJKY014)。

摘　　要：目的制定重大传染病4级预检分诊标准,检验新标准的分级可靠性。方法参照国内外预检分诊体系,结合此次新型冠状病毒肺炎疫情防控实际情况,采用综合评价法制定了重大传染病4级预检分诊标准与流程,2020年1月26日—2月9日来院就诊采用重大传染病4级预检分诊标准的患者进行研究,对其预检分诊分级、病情分级、去向转归等进行描述,通过预检分诊护士与医生对患者分诊级别的比对,计算Kappa值,对分诊一致性进行检验。结果7799例患者,分级构成:I级79例占1.0%,II级371例占4.8%,III级1594例占20.4%,IV级5755例占73.8%。预检分诊护士与医生分诊级别一致性检验Kappa=0.90,表明二者具有高度一致性。结论重大传染病4级预检分诊标准兼顾科学性、准确性、安全性的特点,具有较好的评定者间一致性,在重大传染病流行期间运用,可准确、快速分流就诊患者,在降低院内交叉感染风险的同时,避免漏诊、误诊的发生,对于防止疫情扩散具有重要意义,适合在重大传染病流行期间进一步论证及运用。Objective Development four-level triage system for major infectious diseases,and test the classification reliability of the new standard.Methods In reference to triage system at home and abroad,and combined with the actual situation of the prevention and control of COVID-19's epidemic situation,the criteria and procedure of four-level triage system for major infectious diseases were established by using the comprehensive evaluation method.From January 26 to February 9,2020,patients who came to the hospital for treatment using the four-level pre-examination and triage criteria for major infectious diseases were studied,and their pre-examination and triage classification,disease classification,fate,etc.were described,the Kappa value was calculated by compared the pre-examination and triage nurses and doctors to the patient's triage level,and the consistency of the triage was tested.Results The distribution of triage levels was 1.0%in level-I,4.8%in level-II,20.4%in level-III and 73.8%in level-IV.Pre-inspection triage nurses and doctors triage level consistency test Kappa=0.90,indicating that the two have a high degree of consistency.Conclusion Four-level triage system for major infectious diseases has the characteristics of science,accuracy and safety,and has good consistency among evaluators.when used during the epidemic of major infectious diseases,it can accurately and quickly divert patients and reduce the risk of cross-infection in hospital.avoiding the occurrence of missed diagnosis and misdiagnosis is of great significance to prevent the spread of the epidemic,and is suitable for further demonstration and application during the epidemic period of major infectious diseases.

关 键 词：重大传染病 预检分诊 标准 新型冠状病毒肺炎 

分 类 号：R459.7[医药卫生—急诊医学]