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Objective:To explore the application of effect of healthcare failure mode and effect analysis (HFMEA) in emergency waiting risk management.Methods:From May 2020 to April 2021, totally 87 902 emergency waiting patients from the First Affiliated Hospital of Anhui Medical University were assigned to control group by cluster sampling method. From May 2021 to April 2022, 80 594 emergency waiting patients were assigned to observed group. The patients in the control group received routine emergency waiting of itinerant management mode. In contrast, the patients in the observed group received emergency waiting risk management mode based on HFMEA. The process risk priority number (RPN) and waiting risk management index between two groups were compared.Results:The mean RPN of the observed group was (98.48 ± 8.27) points, significantly lower than that of the control group (251.27 ± 16.95) points. The nurses′ pre-identification rates of changes in the condition and adverse reaction in the observed group were 10.77%(8680/80 594) and 13.37%(10 775/80 594), which were higher than those in the control group, 5.77%(5072/87 902) and 8.12%(7134/87 902), the differences were statistically significant ( χ2 values were 1402.32 and 1221.66, all P<0.05). Conclusions:The application of HFMEA to optimize the emergency waiting management process can effectively reduce the risk of emergency waiting and improve the quality of emergency waiting management.
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@#Introduction: General Hospital`s Emergency Departments (ED) have become focal points for individuals presenting with mental health problems seeking help. However, frontline ED nurses and Assistant Medical Officers (AMOs) often lack the skills and competency to effectively triage and manage clients presenting with a myriad of psychiatric issues. The objective of the study is to assess ED nurses & AMOs ’s perceived competency and associated factors in providing care for clients presenting with psychiatric concerns. Methods: This study is a quantitative, cross-sectional survey design. One hundred and forty-six ED nurses & AMOs were recruited from two tertiary general hospitals in Kota Kinabalu by random sampling. A validated tool (α = 0.92), the Behavior Health Competency Care (BHCC) questionnaire was used to measure psychiatric care competency among participants. Data analyses used descriptive and inferential statistics to identify the association of respondent’s work setting, designation, age, years of work experience, qualification with competency scores. Findings: low total mean score of 2.52(SD 0.68) was found in perceived psychiatric competency among ED nurses & AMOs. Other findings indicate, low perceived competence in risk assessment and poor ability to provide intervention for clients presenting with acute psychiatric conditions. Conclusion: This study found major gaps in psychiatric care competency among ED nurses & AMOs. As ED`s of general hospitals continue to be a focal point for clients with psychiatric disorders seeking help, competency shortfall among frontline ED nurses & AMOs, will negatively affect the quality of psychiatric care delivery and needs to be addressed.
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Objective To explore the effect of extending medical humanities services by using Wechat official account in emergency triage. Methods Since March 2016,emergency triage team has established the WeChat official account called "Great Doc & Mininurse" to conduct an activity of "Emergency Circle". Results Team members of emergency triage have participated in management and maintenance of Wechat Official Account in various degrees. Nursing services have been extended and expanded in the conventional triage foundation, and nursing team has been enhanced while serving for the patients. Conclusions The construction activities of Wechat official account can effectively extend the medical humanistic service,promote the interaction between doctors and patients,and improve the doctor-patient relationship.
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Objective To probe into the emergency triage efficiency between emergency rapid triage system (ERTS) and emergency severity classification of 4 level. Methods A total of 46965 emergency patients from January to December in 2015 were selected as the research object and utilized a data of patients from the electronic triage system, and triaged the emergency patients by means of ERTS retrospectively. A comparison was performed in patient visits, outcome and hospital rates between ERTS and emergency severity classification of 4 level. Results In both of these triage systems, almost 80％of patients are assigned to the lowest acuity (levelⅢandⅣ). The visits of patients with gradeⅢand grade IV diseases were 71.5％(33580/46965), 50.5％(23717/46965) in ERTS and 12.1％(5683/46965), 35.1％(16485/46965) in emergency severity classification of 4 level respectively. The outcomes of patient under the ERTS were better than emergency severity classification of 4 level at levelⅠandⅡ(χ2=11.79, 1100.62, P<0.05). At levelⅠandⅡ, ERTS in the patient's disease hospital admission rates were 70.5％(311/441), 72.6％(5274/7264), which higher than emergency severity classification of 4 level, 62.5％(371/594), 45.2％(2785/6161), the difference was statistically significant (χ2=7.32, 1043.13, P<0.05). At level Ⅲ and Ⅳ, ERTS in the patient's disease hospital admission rates were 9.6％(3676/38288), 7.9％(77/972) , which lower than emergency severity classification of 4 level, 19.3％(4578/23719) , 9.9％(1632/16491), the difference was statistically significant (χ2=1153.10, 4.05, P<0.05). Conclusions ERTS significantly improves the sensitivity and accuracy of emergency triage compared to emergency severity classification of 4 level. ERTS has obvious significance in the emergency patient distribution, and also has a certain advantage in the patient outcomes and hospitalization rates. It can be used as a auxiliary tool.
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Objective To observe the accuracy of the five-level adult emergency triage system (FLAETS) in determining the severity of critically ill patients,and to analyze the factors that influenced the accuracy of the triage.Methods The triage information of patients admitted to Huashan North Hospital Affiliated to Fudan University between 1 year before and 1 year (started in July 2014) after the implementation of the FLAETS were retrospective analyzed.The patients who triaged by FLAETS (from September 2014 to August 2015) were served as observational group,and those manual triaged by modified early warning score (MEWS,from July 2013 to June 2014) were set as control group.The patients with triage of Ⅰ,Ⅱ,and Ⅲ levels were enrolled (fatal,critical,urgent),and the triage results of emergency physicians-in-chief on duty were set as gold standard.The gender,age,triage level,the proportion of over-triage,the proportion of under-triage,and mortality were compared between two groups.The reasons for the overtriage and under-triage were analyzed.The accuracy of FLAETS in determining severity of critically ill patients was calculated.Results 18449 patients were enrolled in observational group,and 720,1641 and 16088 patients were triaged as level Ⅰ,level ⅡⅡ,level Ⅲ respectively;17 378 patients were triaged as critically ill patients according to gold standard,and level Ⅰ,level Ⅱ,level Ⅲ were 637,1476 and 15 265 patients respectively.6 352 patients were enrolled in control group,and level Ⅰ,level Ⅱ,level Ⅲ were 204,771 and 5 377 patients respectively;6002 patients were triaged as critically ill patients according to gold standard,and level Ⅰ,level Ⅱ,level Ⅲ were 308,836 and 4 858 patients respectively.There were no statistically significant differences in gender and age between two groups (both P ＞ 0.05).Compared with the control group,the proportion of over-triage of level Ⅲ was significantly lowered [8.3％ (1 329/16088) vs.12.5％ (674/5 377),P ＜ 0.01],the proportion of under-triage of level Ⅱ and level Ⅲ was significantly lowered [level Ⅱ:0.6％ (9/1 641) vs.7.0％ (54/771),level Ⅲ:0.4％ (63/16088) vs.4.7％ (254/5 377),both P ＜ 0.01].The success rate of resuscitation in observation group was significantly higher than that of control group [80.70％ (619/767) vs.75.23％ (410/545),P =0.020],and the mortality was significantly lowered [1.11％ (193/17 378) vs.2.35％ (141/6002),P =0.037].Over-triages were mainly found in patients with chronic obstructive pulmonary disease (COPD),hypertension and the main complaint of chest tightness,shortness of breath,and under-triages were mainly found in patients with the multiple organ dysfunction in the elder,atypical heart disease and pneumothorax.The accuracy rates of level Ⅰ,level Ⅱ and level Ⅲ in observation group (99.37％,97.42％ and 89.58％) were significantly higher than those of the control group (97.51％,92.54％,and 80.16％,all P ＜ 0.01).Conclusion The FLAETS in determining severity of critically ill patients were objective and reliable,which enable the nurse to better handle the relationship of the emergency and the ordinary,the severe and the mild,the priority and the non-priority,which made the patients received timely and effective treatment.
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Objective To study a quick and effective assessing method used in the emergency trauma patients in order to prevent delaying treatment for patients from overlook or misdiagnosis during triage. Method From 1 January 2006 to 31 September 2006, there were 4023 patients evaluated with trauma assessment method, which was composed of CRAMS scale and trauma assessment program. Results Of 4023 patients, there were 2430 cases with CRAMS below 1( < 7) ,of whom 1979 cases assessed with trauma assessment program were found to be injuried severely to threaten their lives. And more noticeably,of 1593 patients with CRAMS ≥7 there were 46 patients found to have life-threatening injuries assessed with trauma assessment method. Conclutions CRAMS score can be used for triage, and trauma assessment program can be used to evaluate the injuries anatomically. Trauma assessment program and CRAMS employed conjointly can increase the sensitivity and specificity for the stratification of the severity in the injuried patients in order to get a successful triage and lo take advantage of the resources of e-mergency care appropriately.