急诊科危重症患者院内转运的循证实践  

Evidence-based practice for the safety of hospital transport of critically ill patients in the emergency department

作　　者：杨秀芝 侯永超[2] 李瑞艳[2] 郭晓晶 郭莎莎 吴春梅[2] 王菊子[2] Yang Xiuzhi;Hou Yongchao;Li Ruiyan;Guo Xiaojing;Guo Shasha;Wu Chunmei;Wang Juzi(Graduate School of Shanxi University of Traditional Chinese Medicine,Jinzhong Shanxi 030600;Shanxi Provincial People's Hospital,Taiyuan Shanxi 030012)

机构地区：[1]山西中医药大学研究生学院,山西晋中030600 [2]山西省人民医院,山西太原030012

出　　处：《护士进修杂志》2022年第2期116-123,共8页Journal of Nurses Training

基　　金：复旦大学循证护理中心证据转化与临床应用项目(编号:Fudanebn202010)。

摘　　要：目的将急诊科危重症患者院内转运的最佳证据应用于临床实践,促进临床护理质量持续改进。方法本研究以"证据的持续质量改进模式图"为理论框架,运用循证方法检索数据库获取最佳证据并应用于临床,比较最佳证据应用前后系统层面、护士层面及患者层面结局指标的变化。结果系统层面,完善了急诊科危重症患者院内转运制度流程,修订了院内住院核查单和转运评估分级标准并配备分级转运包。护士层面,共审查了32条指标,其中12条指标在证据应用前已达标;除指标5,其它19条在证据应用后达标率均有所提高;知信行水平显著提高(P<0.001)。患者层面,不良事件发生率显著降低(P<0.05);转运准备时长和总时长较证据应用前明显缩短(P<0.01),但转运中和转运后时长无明显变化(P>0.05)。结论基于循证的质量审查项目可改善急诊科危重症患者院内转运的临床实践。Objective To apply the best evidence of in-hospital transport of critically ill patients in emergency department to clinical practice, and to promote the continuous improvement of clinical nursing quality. Methods Based on the theoretical framework of "Model chart of continuous quality improvement of evidence", evidence-based methods were used to retrieve the database to obtain the best evidence and apply it to clinical practice. The changes of outcome indicators at the system level, nurse level and patient level before and after the application of the best evidence were compared. Results At the system level, the system and process of hospital transport for critical patients in the emergency department were improved, and the in-hospital verification list and grading criteria for transport assessment were revised, and graded transport packages were provided.At the nurse level, there were 32 indicators, 12 of which had reached the standard before the application of evidence. Except index 5, the other 19 items have improved the compliance rate after the application of evidence. The level of knowledge, belief and action was significantly increased(P<0.01). The level of knowledge and practice was significantly increased(P<0.001);At the patient level, the incidence of adverse events was significantly decreased(P<0.05);The duration before and after transport was significantly shorter than that before the application of evidence(P<0.01), but there was no significant change in duration during and after transport(P>0.05).Conclusion Evidence-based quality review programs can improve clinical practice for in-hospital transport of critically ill patients in the emergency department.

关 键 词：急诊科 危重症患者 院内转运 循证实践 最佳证据 护理 

分 类 号：R472[医药卫生—护理学]