急诊严重创伤患者输血流程优化的管理实践  

Optimizing management strategies for blood transfusion in the severe trauma patients in the emergency department

作　　者：张屹[1] 狄建忠[2] Zhang Yi;Di Jianzhong(Department of Medical Services,Shanghai Sixth People's Hospital,Shanghai 200230;Office of thePresident,Shanghai Sixth People's Hospital,Shanghai 200230)

机构地区：[1]上海市第六人民医院医务处,上海200230 [2]上海市第六人民医院院长办公室,上海200230

出　　处：《中华急诊医学杂志》2024年第12期1760-1764,共5页Chinese Journal of Emergency Medicine

基　　金：上海交通大学医学院公共卫生事件应急处置“护理预备”项目(GWV-5-TB006)。

摘　　要：目的开展急诊严重创伤患者输血流程优化的管理实践,并探究其应用效果。方法基于严重创伤患者输血准备现状及原因分析,对就诊流程、职责分工、输血流程三方面进行优化,对比2022年7~8月间急诊收治的40名传统输血流程的严重创伤患者和2023年4月40例实施优化流程患者的急诊输血时间节点和治疗效果。通过成组t检验比较分析时间节点,χ^(2)检验比较优化前后患者的抢救成功率。结果(1)流程优化后,严重创伤患者平均急诊输血准备时间较传统流程明显缩短[(28.40±2.72)min vs.(64.83±11.57)min,P<0.01];(2)平均血标本送检时间由(20.83±7.88)min缩短至(7.80±1.59)min,P<0.01;平均取血时间由(15.08±5.72)min缩短至(8.10±2.30)min,P<0.01(;3)优化流程后,患者的抢救室滞留时间由(410.40±157.69)min降至(337.15±74.09)min,P<0.01;(4)流程优化后,抢救成功患者的重症监护室(intensive care unit,ICU)住院时长较传统明显缩短[(13.54±4.82)d vs.(16.61±6.08)d,P<0.05]。结论通过流程优化,进一步规范急诊严重创伤患者输血流程,可缩短各环节滞留时间,提高输血及救治效率。Objectives To conduct an optimizing blood transfusion process for severe trauma patients in the emergency department and investigate its effectiveness.Methods Based on the current situation and analysis of the reasons for the current blood transfusion preparation practices for severely injured patients,the optimization was carried out in three aspects:the medical treatment process,departmental responsibilities,and the blood transfusion process.The differences in the key time links of emergency blood transfusion were compared between 40 patients with severe trauma treated by traditional protocols(July-August 2022)and 40 patients treated by optimized process(April 2023)and the treatment effects were also investigated.T-tests were used to compare the key time links,and chi-square tests were used to compare the rates of successful resuscitation before and after optimization.Results(1)Following process optimization,the average emergency department blood transfusion preparation time for severe trauma patients was significantly reduced compared with the traditional process[(28.40±2.72)min vs.(64.83±11.57)min,P<0.01].(2)Average blood sample submission time decreased from(20.83±7.88)min to(7.80±1.59)min,and average blood retrieval time decreased from(15.08±5.72)min to(8.10±2.30)min,both with P<0.01.(3)Optimized procedures resulted in a reduction of resuscitation room stay time from(410.40±157.69)min to(337.15±74.09)min(P<0.01).(4)Post-optimization,the Intensive Care Unit(ICU)length of stay for successfully resuscitated patients was significantly shorter[(13.54±4.82)days vs. (16.61 ± 6.08) days, P<0.05]. Conclusions Through process optimization, the blood transfusion process for severe trauma emergency patients is further standardized, reducing delays at each stage and improving both transfusion and treatment effi ciency.

关 键 词：急诊 严重创伤 流程优化 管理实践 

分 类 号：R641[医药卫生—外科学]