基于PDSA循环缩短体外心肺复苏转流时间的流程改进  

The application of PDSA method to shorten the time from the initiation of treatment to the start of bypass in cardiac arrest patients receiving ECPR

作　　者：田慈[1] 李姝[1] 葛洪霞[1] 闫静静 马青变[1] Tian Ci;Li Shu;Ge Hongxia;Yan Jingjing;Ma Qingbian(Emergency Department,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院急诊科,北京100191

出　　处：《中国急救医学》2023年第8期632-635,共4页Chinese Journal of Critical Care Medicine

基　　金：睿E(睿意)急诊医学研究专项基金(R2019014)。

摘　　要：目的探讨基于计划-行动-学习-改进(plan-do-study-act,PDSA)循环缩短体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者决定启动治疗至开始转流时间。方法选取PDSA开展前(2017年1月~2021年3月)在急诊科行ECPR的16例患者作为“改进前”组,PDSA开展期间(2021年3月~2022年2月)在急诊科行ECPR 11例患者作为“改进中”组,持续改进期间(2022年3月~2023年6月)在急诊科行ECPR 24例患者作为“改进后”组。运用PDSA质量管理工具,进行ECPR启动及上机流程改进。结果心脏骤停ECPR患者决定启动治疗至开始转流中位时间从改进前56.50 min缩短到改进中40.00 min及改进后34.00 min,差异有统计学意义(P<0.01)。存活率由实施PDSA前的12.5%提升至改进后的17.6%,差异无统计学意义(P>0.05)。结论PDSA能有效缩短心脏骤停接受ECPR患者启动治疗至开始转流时间,提高心脏骤停患者的救治水平,同时建立专业人才梯队,助力教学科研平台建设。Objective To explore the effect of plan-do-study-act(PDSA)method on shortening the time from the initiation of treatment to the start of bypass in the patients with extracorporeal cardiopulmonary resuscitation(ECPR).Methods 16 patients who underwent ECPR in the emergency department before PDSA(January 2017 to March 2021)were selected as the"pre-improvement"group,11 patients who underwent ECPR in the emergency department during PDSA(March 2021 to February 2022)were selected as the"under improvement"group,and 24 patients who underwent ECPR in the emergency department during continuous improvement(March 2022 to June 2023)were selected as the"post-improvement"group.The study used PDSA quality management tool to shorten the time from decision to implement ECPR to start of pump flow and improve the survival rate of cardiac arrest patients.Results The median time from the initiation of treatment to the start of bypass was shortened from 56.5 min to 40 min,and finally 34 min in ECPR patients,with statistically significant differences(P<0.01).Survival rate was improved from 12.5%before PDSA implementation to 17.6%and there was no statistical difference(P>0.05).Conclusions PDSA can effectively shorten the time from the initiation of treatment to the start of bypass in cardiac arrest patients receiving ECPR,improve the quality of treatment for cardiac arrest patients,and establish a team of professional talents to assist the construction of teaching and research platforms.

关 键 词：计划-实施-研究-行动(PDSA)循环 体外心肺复苏(ECPR) 心脏骤停(CA) 

分 类 号：R541.78[医药卫生—心血管疾病]