关键词: 胃肠出血, 医疗失效模式与效应分析, 快速通道, 急症护理, 效果评价

Abstract: Objective To construct a fast nursing track for patients with dangerous upper gastrointestinal tract bleeding and verify its clinical effects. Methods A multidisciplinary team was set up to analyze the failure of the diagnosis and treatment process of patients with dangerous acute upper gastrointestinal bleeding by using healthcare failure mode and effect analysis（HFMEA）combined with the monitoring results of quality control indicators,and to construct a fast track for nursing of patients with dangerous upper gastrointestinal bleeding. The effects of the previous process from May 2020 to April 2021 and the fast track for nursing care of patients with dangerous upper gastrointestinal bleeding from May 2021 to April 2022 were compared. Results The reporting time of hemoglobin was shortened from 21（17,26）min to 7（5,9）min（P<0.001）. The time from the initiation of blood transfusion pro-cess to the start of blood transfusion was shortened from 39（36,45）min to 25（20,30）min（P<0.001）. And the time from start-up of emergency endoscope to implementation was reduced from 50（42,60）min to 40（36,50）min （P=0.001）. The average length of stay in the emergency room was shortened from 236（178,255）min to 180（160, 200）min（P=0.009）. There was significant difference in length of hospital stay between the two groups（P=0.013）,but there was no significant difference in survival outcome（P=0.162）. Conclusion The fast track for nursing care of dangerous upper gastrointestinal bleeding can reduce the time of each key link in the treatment of dangerous upper gastrointestinal bleeding and shorten the length of hospital stay,and ensure the safety of emergency medical treatment.

Key words: Gastrointestinal Hemorrhage, Healthcare Failure Mode and Effect Analysis, Fast Track, Emergency Nursing, Effect Evaluation