縮短ST段上升心肌梗塞病人轉診接受心導管治療時間

Reducing the Time Taken for Referred ST-Segment Elevation Myocardial Infarction Patients to Receive Cardiac Catheterization

張馥蘭(Fu-Lan Chang) ； 簡杏津(Hsing-Chin Chien) ； 曾淑婷(Shu-Ting Tseng) ； 李文領(Wen-Lieng Lee) ； 黃惠美(Hui-Mei Huang) ； 彭月珠(Yueh-Chu Peng)

《彰化護理》 27卷2期 (2020/06) Pp. 34-45

https://doi.org/10.6647/CN.202006_27(2).0008

摘要

急性心肌梗塞，尤以ST段上升心肌梗塞（ST-segment elevation myocardial infarction, STEMI）病人，其預後與症狀發作到血管再灌流的時間呈絕對或高度關聯。本院轉診之STEMI病人因缺乏事前訊息，入院後重新檢查，致使治療延遲，導致血管再灌流的時間最長需時89分鐘，平均耗時62.1分鐘，影響病人預後，經制定STEMI病人轉診快速通關作業流程，藉資訊之便利組成跨院、跨部科STEMI快速通關Line群組，搶先掌握訊息快速啟動心導管團隊；並建立STEMI醫囑套餐，避免耗時診斷及漏開醫囑，簡化相關流程，精益求精，且定期與轉診醫療院所進行院際回饋，以達雙向溝通，使急性ST段上升心肌梗塞且Killip I～II轉診的病人，由原先平均62.1分鐘，縮短至50.7分鐘，達目標值60分鐘，共縮短11.4分鐘。藉此專案提升心肌梗塞病人之照護品質。

關鍵字

急性ST段上升心肌梗塞（STEMI） ； 血管再灌流 ； 縮短轉診心導管時間 ； 護理專案

並列摘要

In patients with acute myocardial infarction, particularly those with ST-segment elevation myocardial infarction (STEMI), the prognosis shows absolute or high correlation with the duration from symptoms to revascularization. As STEMI patients who are referred to our hospital lack past information and require reexamination, their treatment gets delayed, resulting in a maximum revascularization time of 89 minutes and an average revascularization time of 62.1 minutes, which affects the prognosis of the patient. The purpose of the nursing project was to reduce the average time taken for referred acute STEMI patients with Killip I-II to receive cardiac catheterization, to less than 60 minutes. We formulated a rapid clearance process for referred STEMI patients and set up a cross-hospital and cross-department rapid STEMI clearance Line group, provided reeducation for emergency triage nurses, established a set of STEMI medical instructions and carried out advocacy, and regularly submitted feedback to the referred medical institution to achieve bidirectional communication. This led to time taken for referral patients with a definitive diagnosis of STEMI to revascularization was reduced from an average of 62.1 minutes to 50.7 minutes, which fulfilled the target of 60 minutes and was a decrease in 11.4 minutes. The convenience of information technology was utilized to set up a cross-hospital real-time Line group to rapidly obtain information and activate the cardiac catherization team. The time-consuming diagnosis and omission in medical instructions was avoided by using education and establishing a set of medical instructions which simplified the procedure and achieved continuous improvement. Inter-hospital exchange and feedback has resulted in improvement in the care quality of myocardial infarction patients.

並列關鍵字

ST-segment elevation myocardial infarction (STEMI) ； revascularization ； reducing referral and cardiac catherization duration ； nursing project

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