分时分级管理实现方舱医院批量新冠感染者高效应急救治  

Time phased scheduling and Disease grading management to achieve efficient rescue of batches of COVID-19 infected patients in shelter hospital

作　　者：孙颖 苏明华[2] 章晓红[2] 黎嘉嘉[3] 罗婷婷 张允[5] 陈锋[2] 姜涛 吴侗[7] 黄晓波[3] 陈康[2] 吕传柱 Sun Ying;Su Minghua;Zhang Xiaohong;Li Jiajia;Luo Tingting;Zhang Yun;Chen Feng;Jiang Tao;Wu Tong;Huang Xiaobo;Chen Kang;Lv Chuanzhu(Center for Geriatrics and Gerontology,Sichuan Provincial People's Hospital,Sichuan Academy of Medical Sciences,Chengdu 610072,China;Center for Emergency Medicine,Sichuan Provincial People's Hospital,Sichuan Academy of Medical Sciences,Chengdu 610072,China;Department of ICU,Sichuan Provincial People's Hospital,Sichuan Academy of Medical Sciences,Chengdu 610072,China;Department of Infectious Disease,Sichuan Provincial People's Hospital,Sichuan Academy of Medical Sciences,Chengdu 610072,China;Department of Traditional Chinese Medicine,Sichuan Provincial People's Hospital,Sichuan Academy of Medical Sciences,Chengdu 610072,China;Department of Hematology,Sichuan Provincial People's Hospital,Sichuan Academy of Medical Sciences,Chengdu 610072,China;Department of Rheumatology and Immunology,Sichuan Provincial People's Hospital,Sichuan Academy of Medical Sciences,Chengdu 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院老年医学中心,成都610072 [2]四川省医学科学院·四川省人民医院急救中心,成都610072 [3]四川省医学科学院·四川省人民医院重症医学中心,成都610072 [4]四川省医学科学院·四川省人民医院感染科,成都610072 [5]四川省医学科学院·四川省人民医院中医科,成都610072 [6]四川省医学科学院·四川省人民医院血液科,成都610072 [7]四川省医学科学院·四川省人民医院风湿免疫科,成都610072

出　　处：《中华急诊医学杂志》2022年第8期1110-1115,共6页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金(82102575);四川省科技厅重点研发项目(2021YFS0187);中央高校基金-电子科技大学医工结合课题(ZYGX2021YGLH016)。

摘　　要：目的基于灾害救援及急诊分诊理论,以四川援长春医疗队执行长春工人体育馆方舱医院(简称长春工体方舱)救援实践为例,介绍如何快速组建医生团队以实现批量患者的高效应急救治的方法和效果。方法采用横断面分析和前瞻性观察方法开展研究。横断面分析2022年4月支援长春工体方舱医院的四川医疗队医生的基本情况。工作量为2022年4月3月至28日在长春工体方舱的患者总数。在任务开始时、任务第1周、第3周利用五分评分法反映医生身心状态、压力状态和救援成就感。动静态分时舱内外联动排班和患者分级分区管理方案在方舱运行10 d时完成全部实施,对比方案实施前后医生查房效率和自评分变化,总结救援成绩。结果承担长春工体方舱医院运维的四川援长春医疗队56名医生来自14家医院12个专业科室。在常规培训及分工基础上,通过动静态分时舱内外联动排班及基于信息化的患者分区分级管理措施的实施,批量患者入舱收治时间从每人(14.64±10.09)min缩短至(6.80±5.10)min(P<0.01),静态查房时段每位医生每小时可查看患者数从(28.50±12.26)人提高到(68.43±19.95)人(P<0.01),共收治患者1293人,舱区零死亡、零事故、无轻症转重症。35名医生完成连续调查,措施实施前,医生身体状态评分略有下降,方案实施后趋势改善(P<0.01),方案实施前后心理状态评分改善(P=0.03)、压力感受自评分降低(P<0.01)、职业成就感自评分提高(P<0.01),构成比差异有统计学意义。结论根据方舱批量患者应急救治工作特点,对临时召集的医生团队进行基于舱内外联动机制的动静态分时排班和借助信息化技术的患者分级分区管理有利于提高救治工作效率,减少工作压力和风险暴露。Objective To introduce how to quickly set up a doctor team to achieve efficient treatment of batchs COVID-19 patients in Changchun GongTi shelter hospital.Methods A cross-sectional study was conducted to analyze the basic situation of the doctors who supported the Changchun Gongti shelter hospital.The workload is the total number of patients from April 3 to 28,2022.At the beginning of the task,the first week and the third week of the task,the five point scoring method was used to reflect the doctor's physical and mental state,stress state and rescue achievement.The time phased scheduling and disease grading management were fully implemented after 10 days of operation in the shelter.The doctors'ward round efficiency and self scoring changes before and after the implementation of the plan were compared,and the rescue results were summarized.Results Total of 56 doctors(the Sichuan medical assistance team to Changchun),who undertook the work of Changchun Gongti shelter Hospital,came from 12 professional departments of 14 hospitals.By internal and external linkage-time phased scheduling and information-based patient zoning and grading management,the admission time of batch patients was shortened from(14.64±10.09)min to(6.80±5.10)min per person(P<0.05),the number of patients that each doctor can view per hour ranges from(28.50±12.26)to(68.43±19.95)(P<0.01).A total of 1293 patients were treated.There were no deaths,no accidents and no mild illness to severe illness in shelter hospital.35 doctors completed a continuous survey.Before and after the implementation of those measures,the average physical state scores and the psychological state scores of doctors improved(P=0.03),the self-score of stress feeling decreased(P<0.01),and the self-score of professional achievement increased(P<0.01).Conclusions To adapt to the characteristics of emergency treatment for batch COVID-19 patients,the internal and external linkage-time phased scheduling and information-based patient zoning and grading management could help the tempor

关 键 词：新冠疫情 方舱医院 医疗队 医生管理 应急救援 

分 类 号：R197.323[医药卫生—卫生事业管理]