目的 调查浙江省综合医院急诊科预检分诊实施现状与差异,为进一步提高医院急诊预检分诊质量提供依据。方法 采用整群抽样法对浙江省193所二级以上医院急诊预检分诊情况进行问卷调查,调查内容包括急诊科基本情况、急诊预检分诊实施现状及预检分诊人员培训需求等,由急诊科主任或护士长进行填写,浙江省及各地市级急诊质控中心协助落实调查表的发放、回收、校对,调查时间为2022年10月24日—12月6日。结果 最终纳入161所医院,其中7所未设立预检分诊,均为二级医院。154所设立预检分诊,包括三级甲等医院48所、三级乙等医院39所、二级甲等医院47所、二级乙等医院20所。不同等级医院在医院总床位数、抢救室床位数、急诊年就诊人数和危重患者人数、预检分诊设置、人员培训考核、质量控制方面差异均有统计学意义（P<0.05）。85.1%的急诊预检分诊24 h开放,94.2%由急诊护士单独进行预检分诊工作,93.5%采用浙江省急诊预检分诊标准2018年版（四级）,50.0%使用专用软件设备进行院前院内联动,78.6%采用专用电子预检分诊系统进行登记,87.7%要求预检人员有急诊相关工作经验,76.6%进行统一规范的岗前培训,55.8%进行规范的岗位考核,99.4%的医院希望全省急诊预检分诊统一标准,同质化培训需求高达100%。72.1%对急诊预检分诊进行质量控制,44.8%采取分级叫号就诊,29.9%急诊预诊和医生接诊时间有监测预警。不同等级患者预检分诊评估内容各异。结论 浙江省综合医院急诊预检分诊标准和培训需求相对统一,信息化程度高,但缺乏完善的准入标准、培训考核及评价体系,二级医院急诊预检分诊设置参差不齐。今后应不断完善预检分诊制度,提高基层单位急诊服务能力。
Objective To investigate the current status and differences of emergency pre-examination triage in general hospitals in Zhejiang province,so as to provide a basis for further improving the quality and level of hospital emergency triage. Methods Cluster sampling method was used to conduct a questionnaire survey on emergency prescreening and triage in 193 secondary and above hospitals in Zhejiang Province. The survey contents included the basic situation of emergency department,the implementation status of emergency prescreening and triage and the training needs of pre-screening and triage personnel,etc. The director of emergency department or head nurse filled in the questionnaire. Zhejiang Province and municipal emergency quality control centers assisted in implementing the delivery,recovery and checking of the questionnaires,and the investigation time was from October 24,2022 to December 06,2022. Results Finally,161 hospitals were included,among which 7 were secondary hospitals without pre-examination triage. In 154 hospitals,pre-examination triage was set up,including 48 tertiary class A hospitals,39 tertiary class B hospitals,47 secondary class A hospitals and 20 secondary class B hospitals. The total number of beds in hospitals,the total number of emergency patients,the number of critical patients,pre-examination triage settings,personnel training and assessment,quality control were statistically different among different grades of hospitals（P<0.05）. 85.1% of emergency pre-examination and triage were open for 24 hours,94.2% were carried out by emergency nurses alone,93.5% adopted the 2018 edition of Zhejiang Emergency pre-examination and triage standard（Level 4）,50.0% used special software equipment for pre-hospital and in-hospital linkage,and 78.6% used special electronic pre-examination and triage system for registration. 87.7% required pre-screening personnel to have emergency related work experience,76.6% to carry out uniform and standardized pre-job training,55.8% to carry out post assessment,99.4% of hospital desired to unify the standards of emergency triage in the whole province,and the demand for homogeneous training was 100%. 72.1% carried out quality control of emergency pre-examination triage,44.8% adopted hierarchical number calling,29.9% had monitoring and early warning of emergency pre-examination and doctor's receiving time. The contents of pre-examination triage assessment varied among patients in different grade of hospitals. Conclusion Emergency pre-screening and triage standards and training needs of general hospitals in Zhejiang province are relatively uniform,and the degree of information is high. However,there is a lack of perfect access standards,training assessment and evaluation system,and the level of emergency triage in secondary hospitals is low. In the future,the pre-examination and triage system should be continuously perfected to improve the emergency service capacity of primary units.
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