縮短急診急性心肌梗塞病人到達心導管室時間

Reducing Door to Balloon Time for Acute Myocardial Infarction Patients

劉華年(Hwa-Nien Liu) ； 黃燕琴(Yan-Chin Huang) ； 盧素鑾(Su-Luan Lu) ； 周繡玲(Hsiu-Ling Chou)

《新臺北護理期刊》 14卷2期 (2012/09) Pp. 41-51

https://doi.org/10.6540/NTJN.2012.2.005

摘要

背景：美國心臟學會建議急性心肌梗塞病人到達急診就醫90分鐘內，應能接受心導管血管再灌流治療，本院由病人入急診至心導管檢查前準備就耗費94分鐘，而統計心導管血管再灌流治療共耗費129分鐘，嚴重影響病人接受治療的黃金時間，為促成本專案之主要動機。目的：縮短急診急性心肌梗塞病人到達心導管檢查前準備時間。解決方案：縮短心電圖檢查及判讀時間、成立急性心肌梗塞病人醫護團隊、縮短導管室人員到院時間、制定心導管準備指引、製作急性心肌梗塞緊急處置箱及控管電梯快速運送。結果：病人入急診至心導管檢查前準備縮短至52分鐘，而心導管血管再灌流治療共耗費86分鐘。結論：執行過程中透過跨科部合作，院方對於病人安全政策的支持及單位主管對本專案的肯定與持續推動，促使護理人員從不同照護面探討流程改善的可行性，並體認急性心肌梗塞病人於急性期整體評估及其照護的重要性，持續提昇對此類個案的專業照護計劃能力。

關鍵字

急性心肌梗塞 ； 血管再灌流時間 ； 急診

並列摘要

Background: The American Heart Association recommends that the time gap between arrival at the emergency department and intracoronary balloon inflation (door-to-balloon time) during primary percutaneous coronary intervention should be 90 minutes or less. However, it takes our emergency department 94 minutes to perform the pre-cardiac catheterization preparation and a total of 129 minutes to complete the treatment. This treatment delay severely affects the treatment success and is the motivation behind this project.Purpose: The purpose of this project is to reduce the preparation time for acute myocardial infarction patients before going into the catheterization laboratory.Resolutions: To shorten the door to balloon time, we proposed this project to reduce the electrocardiogram and interpretation time, establish an acute myocardial infarction team, reduce staff arrival time at the catheterization laboratory, set up cardiac catheterization preparation guidelines, create an acute myocardial infarction emergency kit, and control elevator transport speed.Results: The patient's pre-cardiac catheterization preparation was reduced to 52 minutes and the total time between arrival at the emergency department and intracoronary balloon inflation (door-to-balloon time) was reduced to 86 minutes.Conclusion: Multidisciplinary collaboration and the hospital's continuous administrative support for this project enabled nursing staff to examine the feasibility of process optimization through different approaches and to understand the importance of assessment and care for acute myocardial infarction patients.

並列關鍵字

Acute myocardial infarction ； Door to balloon time ； Emergency department