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标准化哮喘入院流程有效降低儿科急诊患者滞留时间

2016/03/21

   摘要
   目的:
哮喘是儿童最常见的慢性病,且每年的急诊(ED)量高达600,000人次以上。降低中重度哮喘患者急诊滞留时间,有利于改善此类高风险人群的急诊处理量和护理水平。本研究的目的在于评估标准化的、以呼吸系统评分为基础的入院标准结合目前哮喘临床路径(即标准化的哮喘入院流程;急诊治疗1小时后呼吸系统评分≥9,则入院治疗)对以下指标的影响:入院患者急诊滞留时间(患者急诊登记至转出急诊的时间)、急诊患者住院床位分配时间(患者急诊登记至住院床位分配下来的时间)、整体哮喘入院率、住院患者的住院时间、PICU(儿科重症监护病房)入住率。
   方法:本研究是关于质量改进干预措施的回顾性研究。运用统计过程控制(SPC)评估优化哮喘临床路径实施前后15个月的影响(2010年6月至2012年12月;优化临床路径实施于2011年9月)。
   结果:研究期间共纳入3,688例1-18岁因哮喘急性发作在急诊科就诊的患者。排除不符合哮喘临床路径标准的患者。优化临床路径实施前后患者特征相似。入院哮喘患者平均急诊滞留时间、急诊患者床位分配时间均减少了30分钟。哮喘入院率(34%)、患者平均住院时间(1.4 days)、PICU入住率(2%)没有变化。
   结论:急诊治疗早期,对哮喘患者进行标准化的诊疗,并结合客观性的入院标准进行管理,有利于优化患者护理,提高急诊诊疗效率。

 


 

(杨冬 审校)
Acad Emerg Med. 2016 Jan 4. doi: 10.1111/acem.12890. [Epub ahead of print]


 

 

Standardized Asthma Admission Criteria Reduce Length of Stay in a Pediatric Emergency Department.
 

Rutman L1,2, Migita R1,2, Spencer S2, Kaplan R1,2, Klein EJ1,2.
 

Abstract
OBJECTIVES:
Asthma is the most common chronic illness in children and accounts for >600,000 emergency department (ED) visits each year. Reducing ED length of stay for moderate to severe asthmatics improves ED throughput and patient care for this high risk population. The objective of this study was to determine the impact of adding standardized, respiratory score based admission criteria to an asthma pathway on: ED length of stay for admitted patients; time to bed request; overall percent admitted asthmatics; inpatient length of stay; and percent of PICU admissions.
METHODS:This was a retrospective study of a quality improvement intervention. Statistical process control methodologies were used to analyze measures 15 months before and after implementation of a modified asthma pathway (6/2010 to 12/2012; pathway modification 9/2011).
RESULTS:Three thousand six hundred eighty-eight patients aged 1 through 18 years who presented to an ED with an asthma exacerbation during the study period were included. Patients were excluded if they were not eligible for the asthma pathway. Patient characteristics were similar before and after the intervention. Mean ED length of stay and time to bed request for admitted asthmatics both decreased by 30 minutes. There was no change in percent of asthma admissions (34%), mean inpatient length of stay (1.4 days), or percent PICU admissions (2%).
CONCLUSIONS:Standardizing care for asthma patients to include objective admission criteria early in the ED course may optimize patient care and improve ED flow.

 

Acad Emerg Med. 2016 Jan 4. doi: 10.1111/acem.12890. [Epub ahead of print]

 


上一篇: 与哮喘特异相关的情绪反应在父母和儿童的独立报告:情绪状态、自我行为管理与症状的关系
下一篇: 呼出一氧化氮与哮喘控制有关:一项真实世界的研究

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