基于HFMEA的综合急救方案在AIS静脉溶栓流程中的应用  

A Study of a Comprehensive HFMEA-based First-aid Program Applied in the AIS Intravenous Thrombolysis Process

作　　者：刘琳 郭盛[2] 梁恒娟 杨博 黄小红[2] Liu Lin;Guo Sheng;Liang Hengjuan(Medical College of Shenzhen,Guangzhou University of Chinese Medicine,Shenzhen,Guangdong,518116,China;不详)

机构地区：[1]广州中医药大学深圳临床医学院,广东深圳518116 [2]深圳市龙岗中心医院,广东深圳518116

出　　处：《中国医院管理》2024年第9期41-45,共5页Chinese Hospital Management

基　　金：深圳市卫生健康菁英人才培养项目(JY2021XKG077)。

摘　　要：目的探讨医疗失效模式与效应分析(Healthcare Failure Mode and Effect Analysis,HFMEA)在急性缺血性脑卒中(Acute Ischemic Stroke,AIS)患者静脉溶栓流程中的应用效果。方法通过HFMEA构建有针对性的综合急救方案,对目标医院静脉溶栓流程进行优化,采用t检验、χ^(2)检验和非参数检验对干预前后的关键指标进行评价。结果HFMEA实施后AIS静脉溶栓流程风险优先指数平均值较实施前降低;与常规管理组比较,HFMEA模式管理组发病4.5h内静脉溶栓率增长至54.08%;患者入院至开始静脉溶栓的时间(door to needle time,DNT)中位数缩短、住院费用降低;治疗后1、2周及出院时的美国国立卫生研究院卒中量表评分均减少;但两组患者间的住院日未发生明显变化。结论运用HFMEA管理工具可有效改善AIS患者静脉溶栓流程,提高AIS再灌注治疗率,缩短DNT,且能改善早期神经功能,促进患者健康,减轻家庭负担。Objective To assess the effectiveness of Healthcare Failure Mode and Effect Analysis(HFMEA)in the intravenous thrombolysis process for patients with Acute lschemic Stroke(AIS).Methods The targeted and comprehensive emergency care plan was constructed using HFMEA methodology.This plan was then applied to optimize the intravenous thrombolysis process in the target hospitals.Key indicators were evaluated before and after the intervention using t-tests,chi-square tests,and non-parametric tests.Results After the implementation of HFMEA,the mean Risk Priority Number value for the intravenous thrombolysis process in AIS decreased compared to before implementation.Additionally,the rate of intravenous thrombolysis within 4.5 hours of onset increased to 54%.The HFMEA model management group showed an 8%improvement compared to the conventional management group.The median time between patient admission and the start of intravenous thrombolysis door to needle time(DNT)was shorter,hospitalisation costs were lower,and National Institutes of Health Stroke Scale scores were reduced at 1 and 2 weeks post-treatment,as well as at discharge.However,there was no significant difference in the number of hospital days between the two groups.Conclusion The use of HFMEA management tools can effectively improve the intravenous thrombolysis process in patients with AIS.This can increase the rate of reperfusion therapy in AIS,shorten the time to DNT,and improve early neurological function.Additionally,it can promote patient health and reduce the burden on families.

关 键 词：急性缺血性脑卒中 医疗失效模式与效应分析 静脉溶栓 流程 

分 类 号：R197.323.2[医药卫生—卫生事业管理]