目的 建立危险性上消化道出血患者快速护理通道并验证其临床效果。方法 成立多学科小组,应用医疗失效模式与效应分析并结合质量控制指标的监测结果,对急性上消化道出血患者诊治流程进行失效分析,建立危险性上消化道出血患者快速护理通道。对应用前（2020年5月—2021年4月）与应用后（2021年5月—2022年4月）的效果进行比较。结果 血红蛋白报告时间从21（17,26）min缩短至7（5,9）min（P<0.001）;输血流程启动至实施时间从39（36,45）min缩短至25（20,30）min（P<0.001）;急诊内镜启动到实施时间从50（42,60）min缩短至40（36,50）min （P=0.001）;抢救室平均停留时间从236（178,255）min缩短至180（160,200）min（P=0.009）;两组患者住院时长差异具有统计学意义（P=0.013）,生存结局差异无统计学意义（P=0.162）。结论 危险性上消化道出血患者快速护理通道可缩短各关键环节的救治时间及总体住院时长,保障急诊医疗安全。
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.
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