急性心肌梗死合并心源性休克患者ECMO支持下急诊PCI术流程再造  

Process Reengineering of Emergency PCI Supported by ECMO in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock

作　　者：王彦哲 赵静[1] 杨春晓[1] 刘文彩[1] 位新红 郝恩刚 闫春林[1] WANG Yanzhe;ZHAO Jing;YANG Chunxiao(The Second People's Hospital of Liaocheng City,Liaocheng,Shandong,252600,China;不详)

机构地区：[1]聊城市第二人民医院,山东聊城252600

出　　处：《中国卫生质量管理》2024年第10期18-23,共6页Chinese Health Quality Management

基　　金：山东省医药卫生科技发展计划项目(编号:202103010807);山东省中医药科技项目(编号:2021M030)。

摘　　要：目的基于哈默-流程再造理论优化急性心肌梗死合并心源性休克患者体外膜肺氧合(ECMO)支持下经皮冠状动脉介入术(PCI)救治流程,缩短首次医疗接触-梗死相关动脉开通时间(FMC-To-B)。方法设立流程再造管理团队,梳理原有流程,分析各环节非增值时间占比,制订流程优化方案,包括开发移动PDA,对堆积于急诊科的操作进行前移或后移,构建多学科协作机制,加强救治小组培训,建立多部门协同监管机制。结果流程再造后,FMC-首份心电图时间、FMC-多学科远程会诊时间、FMC-PCI知情同意时间、FMC-ECMO知情同意时间、FMC-To-B时间均较流程再造前缩短。结论再造后的救治流程可有效缩短患者FMC-To-B时间,提高医疗质量。Objective To optimize the treatment process of PCI supported by extracorporeal membrane oxygenation(ECMO)in patients with acute myocardial infarction complicated by cardiogenic shock based on the Hammer-process reengineering model,and to shorten the first medical contact to balloon(FMC-To-B).Methods Through the establishment of a process reengineering management team,combing the original process,analyzing the proportion of non-value-added time in each link of the process,formulating process improvement plans,including the development of mobile PDA,moving forward or moving backward the operations accumulated in the emergency department,establishing a multi-disciplinary collaboration mechanism,strengthening the training of treatment teams,and establishing a multi-sectoral collaborative supervision mechanism.Results After the process reengineering,FMC-first ECG time,FMC-multi-disciplinary remote consultation time,FMC-intervention opening time,FMC-ECMO placement completion time,FMC-To-B time were shorter than before the process reengineering.Conclusion The reengineered treatment process can effectively shorten the FMC-To-B time,improve the medical quality.

关 键 词：急性心肌梗死 心源性休克 体外膜肺氧合(ECMO) 经皮冠状动脉介入术(PCI) 首次医疗接触-梗死相关动脉开通时间(FMC-To-B) 流程再造 医疗质量 

分 类 号：R197.323[医药卫生—卫生事业管理]