急诊胸痛患者结构化分诊审查指标的制订及障碍与促进因素分析

doi:10.3761/j.issn.2096-7446.2026.04.015

摘要/Abstract

摘要：

目的开展急诊胸痛患者结构化分诊的临床审查，构建基于证据的审查指标，系统分析障碍因素及促进因素，制订行动策略。方法以澳大利亚乔安娜布里格斯研究所（Joanna Briggs Institute，JBI）循证卫生保健模式为理论框架，确定临床问题，组建循证团队，系统检索、评价及整合证据，制订审查指标及明确审查方法。在2025年1月1日—3月1日进行临床审查，将证据引入实践策略，分析临床实践过程中存在的障碍和促进因素，并制订相应的变革策略。结果共纳入18条最佳证据，制订15条审查指标，其中10条执行率<80%，3条执行率为0。循证实践的主要障碍因素包括胸痛分诊知识不足、分诊超负荷导致动态监测不足、缺乏电子化模板及质控联动机制等；主要促进因素包括管理层支持循证实践、智慧分诊系统具备开发潜力、护理团队专业素养良好并具备学习动机。针对上述因素，制订了结构化电子分诊路径工具建设、护士分层培训与情境模拟、分诊标准纳入质控体系及多学科协作改进等策略。结论急诊胸痛结构化分诊的最佳证据与临床现状存在显著差距，需通过标准化路径工具、护士分层培训及信息化建设等策略推动证据转化，提升急诊护理质量。

关键词: 胸痛, 急诊, 分诊, 审查指标, 障碍因素, 循证护理学

Abstract:

Objective To conduct a clinical audit on structured triage for emergency chest pain patients，establish evidence-based audit indicators，systematically analyze barriers and facilitators，and develop action strategies. Methods Using the Joanna Briggs Institute（JBI） Evidence-Based Healthcare Model as the theoretical framework，clinical questions were defined，and an evidence-based team was formed to systematically retrieve，evaluate，and synthesize evidence. Audit criteria and methods were developed. A clinical audit was conducted from January 1 to March 1，2025，using the Evidence-Practice Integration Strategy to analyze barriers and facilitators in clinical practice and formulate corresponding change strategies. Results A total of 18 best evidence items were included，and 15 audit indicators were developed. Among them，10 indicators had an implementation rate of <80%，and 3 indicators were 0. Major barriers to evidence-based practice included insufficient knowledge of chest pain triage，insufficient dynamic monitoring due to triage overload，and the lack of electronic templates and quality-control linkage mechanisms. Key facilitators included managerial support for evidence-based practice，the developmental potential of intelligent triage systems，and a nursing team with strong professional competence and motivation to learn. Based on these factors，targeted strategies were formulated，including the development of a structured electronic triage pathway，tiered nurse training with scenario simulation，integration of triage standards into the quality-control system，and establishment of a multidisciplinary collaborative improvement mechanism. Conclusion There is a significant gap between the best evidence and the current clinical status of structured triage for acute chest pain. Promoting evidence translation requires standardized pathway tools，tiered nurse training，and enhanced informatics construction to improve the quality of emergency nursing care.

Key words: Chest Pain, Emergency, Triage, Audit Criteria, Barriers, Evidence-based Nursing

胡紫薇, 欧阳兰欣, 柯海明, 林印, 刘迪. 急诊胸痛患者结构化分诊审查指标的制订及障碍与促进因素分析[J]. 中华急危重症护理杂志, 2026, 7(4): 469-475.

HU Ziwei, OUYANG Lanxin, KE Haiming, LIN Yin, LIU Di. Development of audit indicators for structured triage of emergency chest pain patients and analysis of barriers and facilitators[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(4): 469-475.

图/表 2

参考文献 27

[1]	国家心血管病中心, 中国心血管健康与疾病报告编写组, 胡盛寿. 中国心血管健康与疾病报告2023概要[J]. 中国循环杂志, 2024, 39(7):625-660.
	National Center for Cardiovascular Diseases, the Writing Com-mittee of the Report on Cardiovascular Health, Hu SS, et al. Report on cardiovascular health and diseases in China 2023:an updated summary[J]. Chin Circ J, 2024, 39(7):625-660.
[2]	Reamy BV, Williams PM, Odom MR. Pleuritic chest pain:sort-ing through the differential diagnosis[J]. Am Fam Physician, 2017, 96(5):306-312.
[3]	周璇, 郑若菲, 简钢仁, 等. 胸痛患者急诊预检分诊的研究进展[J]. 中华护理杂志, 2022, 57(16):2036-2041.
	Zhou X, Zheng RF, Jian GR, et al. Research progress of emer-gency triage in patients with acute chest pain[J]. Chin J Nurs, 2022, 57(16):2036-2041.
[4]	Saleh ZT, Aslanoglu A, Al-Dgheim R, et al. Effectiveness of triage professionals’ knowledge and experience on their ability in early diagnosis and consequent treatment of acute coronary syndrome:a literature review study[J]. Res J Pharm Technol, 2024:4075-4082.
[5]	Leung YK, Cheng NM, Chan CP, et al. Early exclusion of major adverse cardiac events in emergency department chest pain patients:a prospective observational study[J]. J Emerg Med, 2017, 53(3):287-294. doi: 10.1016/j.jemermed.2017.05.006
[6]	中华医学会急诊医学分会, 中国医疗保健国际交流促进会胸痛分会, 急性胸痛急诊诊疗专家共识[J]. 中华急诊医学杂志, 2019, 28(4):413-420.
	Emergency Medical Branch of Chinese Medical Association, Chest Pain Branch of China International Exchange and Pro-motive Association for Medical and Health Care. Expert consensus on emergency diagnosis and treatment of acute chest pain[J]. Chin J Emerg Med, 2019, 28(4):413-420.
[7]	Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain:a report of the American College of Cardiology/American Heart Association joint committee on cli-nical practice guidelines[J]. Circulation, 2021, 144(22):e368-e454.
[8]	Ameri M, Shahhoseini S, Goli S, et al. Factors affecting triage accuracy in patients with a definitive diagnosis of acute myo-cardial infarction[J]. Australas Emerg Care, 2021, 24(2):81-83. doi: 10.1016/j.auec.2020.09.004
[9]	Sanders SF, DeVon HA. Accuracy in ED triage for symptoms of acute myocardial infarction[J]. J Emerg Nurs, 2016, 42(4):331-337. doi: 10.1016/j.jen.2015.12.011 pmid: 26953510
[10]	Anderson J, Murphy R, Darcy P, et al. 8 Quality improvement measures to reduce the time to ECG in patients self-presen-ting with chest pain[C]// Moderated poster session 1. BMJ Pub-lishing Group Ltd and British Cardiovascular Society, 2023:A7-A8.
[11]	Keats A, Moran D, Rothwell S, et al. A quality improvement project to reduce door-to-electrocardiogram time:a multicenter study[J]. J Saudi Heart Assoc, 2018, 30(3):180-187. doi: 10.1016/j.jsha.2017.11.005
[12]	朱政, 胡雁, 周英凤, 等. 推动证据向临床转化(五)证据临床转化研究中的文献质量评价[J]. 护士进修杂志, 2020, 35(11):996-1000.
	Zhu Z, Hu Y, Zhou YF, et al. Promotion evidence to clinical transformation:Evidence resource retrieval for the purpose of clinical transformation[J]. J Nurses Train, 2020, 35(11):996-1000.
[13]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[14]	周英凤, 朱政, 胡雁, 等. 推动证据向临床转化(七)证据的可用性评价[J]. 护士进修杂志, 2020, 35(13):1193-1196.
	Zhou YF, Zhu Z, Hu Y, et al. Implementing evidence into practice:How to evaluate the applicability of evidence[J]. J Nurses Train, 2020, 35(13):1193-1196.
[15]	周英凤, 朱政, 胡雁, 等. 推动证据向临床转化(八)审查指标的构建[J]. 护士进修杂志, 2020, 35(14):1281-1284.
	Zhou YF, Zhu Z, Hu Y, et al. Implementing evidence into pra-ctice:How to develop the clinical audit criteria[J]. J Nurses Train, 2020, 35(14):1281-1284.
[16]	Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guide-lines for the management of acute coronary syndromes[J]. Eur Heart J, 2023, 44(38):3720-3826. doi: 10.1093/eurheartj/ehad191
[17]	Kontos MC, de Lemos JA, Deitelzweig SB, et al. 2022 ACC expert consensus decision pathway on the evaluation and disposition of acute chest pain in the emergency department:a report of the American college of cardiology solution set oversight committee[J]. J Am Coll Cardiol, 2022, 80(20):1925-1960. doi: 10.1016/j.jacc.2022.08.750
[18]	中国医疗保健国际交流促进会胸痛分会胸痛护理学组, 山东大学齐鲁医院, 急性胸痛护理临床实践指南的构建[J]. 中华急危重症护理杂志, 2023, 4(6):519-525.
	Chest Pain Nursing Group of Chest Pain Branch of China International Ex-change and Promotive Association for Medi-cal and Health Care, Qilu Hospital of Shandong University. Construction of clinical practice guideline for acute chest pain nursing[J]. Chin J Emerg Crit Care Nurs, 2023, 4(6):519-525.
[19]	Hollander JE. Approach to the adult with nontraumatic chest pain in the emergency department[EB/OL].[2024-12-10]. https://www.uptodate.com/contents/approach-to-the-adult-with-nontrauma-tic-chest-pain-in-the-emergency-department.
[20]	Porritt K, Ortega-Arroyo A. Chest pain:initial assessment of su-spected cardiac chest pain[J]. The JBI EBP Database, 2024,JBI-ES-3835-4.
[21]	Reeder GS. Initial evaluation and management of suspected acute coronary syndrome(myocardial infarction,unstable angina) in the emergency department[EB/OL].[2024-12-10]. https://www.uptodate.com/contents/initial-evaluation-and-management-of-suspected-acute-coronary-syndrome-myocardial-infarction-unsta-ble-angina-in-the-emergency-department.
[22]	National Institute for Health and Care Excellence. Recent-onset chest pain of suspected cardiac origin:assessment and diagnosis[EB/OL].[2024-12-10]. https://www.nice.org.uk/guida-nce/cg95.
[23]	Brown JE. Assessment of chest pain[EB/OL].[2024-12-10]. https://bestpractice.bmj.com/topics/en-gb/301.
[24]	急诊预检分诊专家共识组. 急诊预检分诊专家共识[J]. 中华急诊医学杂志, 2018, 27(6):599-604.
	Emergency Pre-screening and Triage Expert Consensus. Expert consensus on emergency pre-inspection and triage[J]. Chin J Emerg Med, 2018, 27(6):599-604.
[25]	Sutton RT, Pincock D, Baumgart DC, et al. An overview of cli-nical decision support systems:benefits,risks,and strategies for success[J]. NPJ Digit Med, 2020, 3:17. doi: 10.1038/s41746-020-0221-y pmid: 32047862
[26]	Licata S, Deroma L, Fresco C, et al. Virtual Reality simulation training improves health professionals’ knowledge in STEMI critical care[J]. Eur J Public Health, 2023, 33(Supplement_2):ckad160.806.
[27]	Kuşcu Karatepe H, Türkmen E. Nurse performance:a path model of clinical leadership,creative team climate and structural empowerment[J]. J Clin Nurs, 2023, 32(3/4):584-596. doi: 10.1111/jocn.v32.3-4