The Research of Improving Hospital Emergency Procedures in Patients with Acute Myocardial Infarction-Take a Medical Center as an Example

改善醫院急性心肌梗塞病人急救流程之研究－以某醫學中心為例

曾文昌(Wen-Chang Tseng) ； 詹富超(Fu-Chao Chan) ； 張智鈞(Chih-Chun Chang) ； 王永成(Yung-Cheng Wang) ； 林康平(Kang-Ping Lin) ； 何鎔莉(Jung-Li Ho) ； 陳偉琪(Wei-Chi Chen)

《中華放射線技術學雜誌》 45卷4期 (2021/12) Pp. 199-211

摘要

8 Disciplines is a methodology for industry to quote product manufacturing steps, implement improvements and solve problems. The 8D framework emphasizes the team's consensus spirit in the eight criteria, so its primary spirit is when a problem occurs, find a suitable corrective measure to prevent the problem from recurring. Therefore, we expect to use the 8D approach to carry out the process of first aid time for acute myocardial infarction was improved, the lengthy admission and diagnosis process was solved. The time for patients to undergo treatment from the emergency room to the cardiac catheterization room (D2B) was shortened, and the long waiting period for inspection procedures was eliminated, and rescue the time is shortened to less than 90 minutes to reduce mortality. The theme of the qualitative research method is set as D1. Establish cross-disciplinary communication group, D2. Problem analysis, D3. Emergency improvement measures, D4. Define and verify the true cause, D5. Implement permanent corrective measures, D6. Confirm the effectiveness of permanent countermeasures, D7. Prevent recurrence, and D8. According to the procedure sequence of acute myocardial infarction before improvement, 8D technique was used to determine the true cause and formulate the countermeasures. The results show that (1) D2B improved from 174 minutes before improvement to less than 60 minutes, which was less than 90 minutes recommended by the international treatment guidelines and reached statistical significance (P ＜ 0.001), (2) The rate of receiving the first balloon expansion within 90 minutes after arriving at the hospital has increased from 5.1% before improvement to 94.9% after improvement, (3) The rate of patients with acute myocardial infarction completing ECG within 10 minutes after admission was improved from 38.6% to 97.2%. We also use FMEA to improve the failure mode and effect analysis, after the countermeasures were implemented, the D2B time was shortened, and the incidence and mortality of myocardial infarction were reduced. This improvement can save at least six lives per 100 people every year.

關鍵字

8D ； acute myocardial infarction

並列摘要

8 Disciplines（8步驟問題解決法）內容在強調團隊的共識精神，即是：當問題發生時，找出一個合適的矯正措施，避免事件再度發生；因此，我們期望運用問題解決法的八個步驟來改善本院急性心肌梗塞急救流程，縮短病人從急診室至心導管室（D2B）施做治療的時間至90分鐘之內，以降低死亡率。本質性研究法的主題設定為：D1.成立跨科別溝通小組、D2.問題解析、D3.應急改善措施、D4.界定及驗證真因、D5執行永久矯正措施、D6.確認永久對策之有效性、D7.防止再發生，以及D8.改善的作業流程標準化及未來方向。結果顯示：1.D2B由改善前的174分鐘，進步至改善後少於60分鐘，遠低於國際90分鐘建議值及達到統計意義（P＜0.001），2.到院90分鐘接受第一次氣球擴張比率，由原來改善前的5.1％，進步至改善後的94.9％。3.急性心肌梗塞病人到院10分鐘內完成心電圖的比率，由原來改善前的38.6％，改善至97.2％。我們同時運用FMEA改善失效模式與效應分析；經對策實施後，縮短D2B時間，降低了病人心肌梗塞發生率及死亡率；此改善每年每100人可救回至少六個人的生命。

並列關鍵字

8D ； 急性心肌梗塞