縮短胸痛病人到急診室後接受心電圖檢查時間之改善方案

An Improvement Project on Door-to-ECG Time for Patients with Chest Pain in the ED

余秝萱(Li-Hsuan Yu) ； 李作英(Tso-Ying Lee) ； 陳冠群(Kuan-Chun Chen) ； 蔡淑珍(Head Su-Chen Cai)

《領導護理》 16卷1期 (2015/03) Pp. 73-86

https://doi.org/10.29494/LN.201503_16(1).0008

摘要

心電圖檢査是急診室醫師用於診斷急性冠心症之檢驗方式中最方便、迅速且不具侵入性之檢査。面對胸痛症狀病人時，應儘速進行鑑別診斷，在短時間內進行心電圖檢査，以作爲醫療決策及處置依據。依據醫院緊急醫療能力分級評定之基準，胸痛病人到院至執行第一張心電圖時間應有70%小於10分鐘，但本院僅達50.9%，且平均時間高達17.9分鐘，故成立跨團隊小組，從改善流程、調整人力結構及增購設備，並導入資訊環境以進行改善。改善後，急診胸痛病人到院至執行第一張心電圖時間小於10分鐘之百分比提高爲81%；平均時間縮短爲8.6分鐘。本專案之額外效益爲醫、護、資訊單位跨單位高度合作，建立即時通訊系統，爲病患安全進行更嚴謹的把關。

關鍵字

胸痛 ； 心電圖檢查 ； 急診室 ； 到院後心電圖檢查時間

並列摘要

ECG (electrocardiogram) is the most effective and convenient non-invasive test for physicians to use in the diagnosis of acute coronary artery syndrome. ECG tests should be done as soon as possible for patients with chest pain; thereafter, physicians may make intervention decisions based on different possible diagnoses from the ECG test results. A ccording to the Hospital Emergency Medical Capability Classification Standard, an ECG should be done within 10 minutes for 70% of chest pain patients on their arrival to the ED (emergency department). However, in the hospital where the author worked, only 50.9% of patients with chest pain received door-to-ECG within 10 minutes, with an average of 17.9 minutes. The improvement project entailed establishing an interdisciplinary team, improving the process workflow, adjusting the workforce structure, purchasing more ECG equipment, and building an information technology system for further improvement. With these measures, 81% of patients with chest pain obtained door-to-ECG test within 10 minutes. The average time shortened to 8.6 minutes. The bonus benefits of this project included greater coordination among disciplinary team members and the formation of a communication system that would promote patient safety.

並列關鍵字

chest pain ； electrocardiogram ； emergency department ； door-to-ECG time

參考文獻

Chen, K. C., Yen, D. H., Chen, C. D., Young, M. S., & Yin, W. H. (2011). Effect of emergency department in-hospital tele- electrocardiographic triage and interventional cardiologist activation of the infarct team on door- to- balloon times in ST- segment- elevation acute myocardial infarction. American Journal of Cardiology, 107(10), 1430-1435. doi: 10.1016/j.amjcard.2011.01.015.

Schreier, N. K., Moltchanova, E. V., Lammi, N. M., Karvonen, M. L., & Eriksson, J. G. (2009). Temporal variation in case fatality of acute myocardial infarction in Finland. Annals of Medicine, 41(1), 73-80. doi: 10.1080/07853 890802392511.

Takakuwa, K. M., Burek, G. A., Estepa, A. T., & Shofer, F. S. (2009). A method for improving arrival-to-electrocardiogram time in emergency department chest pain patients and the effect on door-to-balloon time for ST-segment elevation myocardial infarction. Academic Emergency Medicine, 16(10), 921-927. doi: 10.1111/j.1553-2712.2009.00493.x. Epub 2009 Sep 15.

林世崇 、 呂炎原 、 徐漢仲 ( 2013 ) , 心肌梗塞之重新定義與臨床分類 . 內科學誌 , 24 , 1-11

周嘉裕 ( 2010 ) , 急性心衰竭的診斷與治療 - 準則應用與建議 . 重症醫學雜誌 , 11 ( 3 ) · 161-187