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【論文摘要】利用現場影像回顧設立當地到院前心肺功能停止品管指標改善急救品質
【論文摘要】Establish Local Out-of-hospital Cardiac Arrest Quality Management Indicator and Improve Quality of Resuscitation by Video Review
摘要
以往為了要提升當地到院前心肺功能停止（Out-of-hospital cardiac arrest, OHCA）的急救成功率及存活率，會借鏡其他縣市或國家的資料做為參考依據，但礙於各地的流程、出勤人數、出勤人員等級的不同，讓品管做起來窒礙難行，回饋出勤人員的成效也不佳。筆者利用新竹市消防局第二大隊三民分隊110年度OHCA案件現場影像記錄各項急救處置施行時間點，訂定品管項目，計算所需平均時間，選出操作較優異的組別，設為品管指標，並採三階段分級模式，給予顏色註記，分別為良好（綠色）、尚可（黃色）、加強（紅色），相較於數字更能強化感受度，並於回饋表下方提供出勤人員改善方案。三民分隊在110年至111年6月間共接獲58件成人內科OHCA，扣除影像不完全及2項以上處置未執行者共38件納入分析。利用影像回顧方式並定義各項急救處置時間，110年時平均處置時間為評估OHCA所耗時間11秒、確認OHCA至開始壓胸時間31秒、AED開機至貼上貼片時間39秒、給第一口氣206秒、完成進階呼吸道303秒、架設M-CPR所耗時間40秒。111年開始使用品管回饋單模式，人員出勤後收到回饋表單，再由分隊端訓練進行急救影像回顧及原位模擬改善缺失，經統計後各項指標皆有提升，藉此可知執行OHCA品管回饋搭配訓練可以改善急救品質。
關鍵字
無資料並列摘要
In order to improve return of spontaneous circulation (ROSC) rate and survival rate in out-of-hospital cardiac arrest (OHCA), we usually refer to the mode of other county or country. It is hard to do because another place has another way. Especially give member feedback. This study was conducted using data obtained from Hsinchu city fire bureau Sam-Min station between January 2021 and December 2021.We recorded the time point, calculated the average time of each first -aid treatment of the case in OHCA. Then we set the quality management indicator and selected the group which had good performance as benchmark. So as to enhance the feeling of OHCA case feedback, the quality management feedback form used the color marking in each performance target. The color has green, yellow and red which represent excellent, good and bad. Among the internal medicine OHCA case in adult which dispatched by Sam-Min station, 38 cases were included in final analysis after deducting video incomplete and two or more treatment didn't execute. Using video review method to define each first-aid treatment time point, the average of firstaid treatment time from January 2021 to December 2021 was 11 seconds in recognize OHCA, 31 seconds in recognize OHCA to cardiopulmonary resuscitation (CPR), 39 seconds in turn on AED to place the pads, 206 seconds in first ventilation after EMS recognize OHCA, 303 seconds in insertion of advanced airway, 40 seconds in setting mechanical CPR. In January 2022, the quality management feedback form was used. Each member of OHCA case received feedback form after mission completed. They train by video reviewed and in-stiu simulation with feedback form to improve the lack of case. After statistics, all indicators have improved, which shows that the implementation of OHCA quality management feedback combined with training can improve the quality of resuscitation care.