上海重症救治体系发展制约因素分析  

Analysis of factors restricting the development of the critical care system in Shanghai

作　　者：袁素维 罗诚祖[1] YUAN Suwei;LUO Chengzu(Renji Hospital Affiliated with Shanghai Jiao Tong University School of Medicine,Shanghai,200127,PRC)

机构地区：[1]上海交通大学医学院附属仁济医院,上海市200127

出　　处：《中国医院》2024年第6期37-40,共4页Chinese Hospitals

基　　金：国家自然科学基金青年项目(72004136);上海市2023年度卫生健康政策研究课题(2023HP84)。

摘　　要：目的:分析当前制约上海市重症救治体系发展的主要因素。方法:采用专家咨询法确定评价工具,对上海市二、三级医院重症医学岗位医护人员开展在线问卷调查,共回收有效样本582人。结果:重症救治体系包括重症临床专科建设、重症病人救治多学科融合体系以及重症病人分级转诊体系3个维度。重症临床专科建设最主要制约因素是场地设备投入成本高昂;医院层面缺乏工作制度是影响重症医学与其他专科交叉合作的主要因素;缺乏具体可落地的政策支持是影响重症病人分级转诊的主要因素。不同级别医院对于人员短缺问题的判定存在显著差异(P=0.026),不同岗位人员对工作强度和转诊中潜在医疗风险的判定也存在显著差异(P=0.009、0.048)。结论:一是加强重症救治体系建设相关细化制度;二是医院需进一步整合资源,打造一体化重症救治平台;三是多措并举,缓解重症人员短缺瓶颈。Objective:To analyze the main factors currently restricting the development of the critical care system in Shanghai.Method:An expert consultation method was used to determine the evaluation tools,and an online questionnaire survey was conducted among medical and nursing staff in critical care positions at Grade II and Grade III hospitals in Shanghai,with 582 valid responses collected.Results:The critical care system includes three dimensions:construction of critical care clinical specialties,multidisciplinary integration system for critical patient care,and a graded referral system for critical patients.The main constraining factor for the construction of critical care clinical specialties is the high cost of space and equipment;the lack of institutional frameworks at the hospital level is the main factor affecting the collaboration between critical care medicine and other specialties;the lack of specific,actionable policy support is the main factor affecting the graded referral of critical patients.There are significant differences in the perception of staffing shortages between hospitals of different levels(P=0.026)and in the assessment of work intensity and potential medical risks during referrals among different staff positions(P=0.009,0.048).Conclusion:First,refine the systems related to the construction of the critical care system;second,hospitals need to further integrate resources to create an integrated critical care platform;third,multiple measures should be taken to alleviate the bottleneck of staffing shortages in critical care.

关 键 词：重症急救 重症救治 重症医学 制约因素 

分 类 号：R197[医药卫生—卫生事业管理]