重症体外膜肺氧合患者院际转运风险管理

目的探讨重症患者体外膜肺氧合(extracorporeal membrane oxygenation,EMCO)院际转运风险管理。方法回顾性分析2012年6月-2017年7月共有116例EMCO院际转诊,收集到98例临床资料(84.5%)的性别等基本资料,转运时长、转运距离、18.00-08.00点到达(%)、转运人员级别合格率(%)等转运特点资料,转运病种以及不良事件发生例数(包含与患者相关(P-AEs)和与转运设备或人员相关(E-AEs)两大类)进行统计学分析等。结果院际转运患者中(88人)来自省内18家协作医院;剩余(10人)来自省外4家ICU。3家ICU转运10例以上患者;5家ICU转运5~9例;其他ICU转运1~4例。超过1/3院际转运发生在夜晚(即18.00到08.00之间)到达;患者转运评估风险级别与转运人员等级相匹配合格率达90%;转运病种以重症肺炎为主,98次转运中只有5次发生不良事件(5.1%),但不良事件发生总例数为13例(13.2%)发生时间段主要分布在前期2013-2015年期间。与患者相关转运不良事件发生6例(6.1%)与转运设备或人员相关转运不良事件发生7例(7.1%),其中通信事件发生2例(2.0%),1例为转运时间计划不合理,1例为患者病情沟通出现差错。危险交通状况发生1例(1.0%)为司机疲劳驾驶等。结论构建区域性EMCO重症患者院际转运风险管理预警机制,形成以郑州大学第一附属医院体外支持团队为中心,重症患者院际转运中心为平台,EMCO重症患者院际转运小组为移动ECMO小组,集急救、转运、通讯、联络和培训为一体化向地区协作医院线性辐射的“中心-辐射”型EMCO重症患者医疗体系,明显降低EMCO重症患者院际转运不良事件发生率,保证EMCO院际转运患者安全与成功。同时,在降低医疗成本、医疗资源、患者并发症以及最重要的是提升ECMO院际转运质量等方面获得最大收益。

Risk management of inter-hospital transfer in patients with severe extracorporeal membrane oxygenation

Objective To explore the risk management of extracorporeal membrane oxygenation(EMCO)for inter-hospital transfer in critically ill patients.Methods A retrospective analysis of 116 cases of EMCO inter-hospital transfer from the First Affiliated Hospital of Zhengzhou University from June 2012 to July 2017.Basic data such as gender,98 patients,clinical data(84.5%)were collected.Data on transfer characteristics such as the qualification rate of transfer personnel,statistical analysis of transfer disease types and adverse events(including two categories of patient-related(P-AEs)and transfer equipment or personnel-related(E-AEs)).Results Among the inter-hospital transfer patients(88 people)came from 18 cooperative hospitals in the province;the remaining(10 people)came from 4 ICUs outside of the province.Three ICUs transferred more than 10 patients;5 ICUs transferred 5 to 9 cases;other ICUs transferred 1 to 4 cases.More than 1/3 of the inter-hospital transfers arrived at night(between 18.00 and 08.00);the patient's transfer assessment risk level matched the transfer personnel's grade and the eligibility rate reached 90%;the transfer disease was mainly pneumonia,and 98 transfers There were only 5 adverse events(5.1%),but the total number of adverse events was 13(13.2%).The lime period was mainly distributed in the previous period from 2013 to 2015.There were 6(6.1%)adverse events related to patient transfer and 7(7.1%)adverse events related to transfer equipment or personnel,of which 2(2.0%)were communication events,and 1 was an unreasonable transfer schedule.One case was an error in communication of the patient's condition.One case(1.0%)of a dangerous traffic situation occurred when the driver was fatigued.Conclusion The risk management mechanism for inler-hospilal transport of patients with EMCO was established,and form a support team for the Center Court in vitro,patients with severe Intercollegiate transit center as a platform,inter-hospital transport of critically ill patients EMCO group for mobile ECMO team,set first aid,transport,communications,contact and training for the integration of linear radiation to the areas of cooperation hospital health care system in patients with severe EMCO,reducing the incidence of adverse events in inter-hospital transport of EM・CO critical patients,and ensuring the safety and success of EMCO inter-hospital transport patients.Al the same time,it has achieved the greatest benefits in reducing medical costs,medical resources,patient complications,and most importantly,improving the quality of ECMO inter-hospital transfer.