急诊严重创伤患者救治时效质量评价指标的构建及应用研究

doi:10.3761/j.issn.2096-7446.2025.09.006

摘要/Abstract

摘要：

目的构建急诊严重创伤患者救治时效质量评价指标并评价效果。方法以三维质量评价模型为理论框架，通过文献检索、小组讨论、德尔菲法及层次分析法构建急诊严重创伤患者救治时效质量评价指标。选取南通市某三级甲等医院急诊抢救室2024年6月—8月收治的严重创伤患者为试验组，3月—5月收治的严重创伤患者为对照组，两组患者均遵循既定的抢救流程进行护理，试验组根据评价指标制订检查表进行质量控制，比较两组护士指标执行情况。结果最终形成的评价指标包括3项一级指标、13项二级指标、40项三级指标。2轮专家函询问卷回收率分别为86.67%、100%，专家的权威系数为0.800、0.840，肯德尔和谐系数为0.284、0.321，第2轮函询中各条目的变异系数为0.01~0.21。评价指标应用后，患者血型和血常规10 min送检达标率、30 min完成输血达标率以及30 min完成CT达标率上升，差异具有统计学意义（P<0.05）。此外，护士对患者初次疼痛评估及体温监测的完成情况改善（P<0.05），但多数指标在后续的动态评估中并未持续展现出显著的改善趋势。结论该研究构建的指标科学可靠、内容全面，可为落实急诊严重创伤患者的标准化、细节化护理提供参考。

关键词: 急诊, 严重创伤, 时效, 质量指标, 护理管理研究

Abstract:

Objective To develop an evaluation index system of treatment timeliness quality for emergency severe trauma patients and to evaluate its effectiveness. Methods Based on three-dimensional quality structure model，the literature search，group discussion，Delphi method and analytic hierarchy process were used to determine the contents and weight of evaluation index system. Patients with severe trauma admitted to the emergency rescue room of a tertiary grade A hospital in Nantong City from March to May 2024 were selected as the control group，patients from June to August were in the experimental group. Both groups of patients followed the established rescue process for severe trauma patients in our hospital for nursing care. The quality control in the experimental group was implemented by the quality control standards and checklists based on the constructed evaluation indicators for emergency treatment of severe trauma patients. The implementation status of indicators by nurses were compared between the two groups. Results The evaluation index system included 3 first-level indexes，13 second-level indexes and 40 third-level indexes. Effective recovery rates of two rounds of expert consultation were 86.67% and 100%，expert authority coefficients were 0.800 and 0.840 respectively，coefficients of concordance were 0.284 and 0.321，the coefficients of variation for each item in the 2nd round of correspondence were 0.01~0.21. After the implementation of evaluation indicators，significant improvements were observed in compliance rates for blood type and CBC sample delivery within 10 minutes，blood transfusion completion within 30 minutes，and CT scan completion within 30 minutes，with statistically significant differences（P<0.05）. Additionally，nurses demonstrated marked improvement in completing initial pain assessments and body temperature monitoring（P<0.05）. However，most indicators did not demonstrate a sustained significant improvement trend in subsequent dynamic evaluations. Conclusion The constructed evaluation indicators of treatment timeliness quality for emergency severe trauma patients is scientific，reliable and comprehensive，which can provide reference for implementing standardized and detailed nursing care for acute severe trauma patients.

Key words: Emergency, Severe Trauma, Timeliness, Quality Indicators, Nursing Administration Research

王伶俐, 刘小琴, 陈天喜, 赵旭东, 冒飒娴, 薛施霞, 姜慧. 急诊严重创伤患者救治时效质量评价指标的构建及应用研究[J]. 中华急危重症护理杂志, 2025, 6(9): 1061-1066.

WANG Lingli, LIU Xiaoqin, CHEN Tianxi, ZHAO Xudong, MAO Saxian, XUE Shixia, JIANG Hui. Construction and application of an evaluation index system of treatment timeliness quality for emergency severe trauma patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(9): 1061-1066.

图/表 2

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