The Effect of Continuous Improvement of Quality Control Mechanism on the Emergency Treatment Efficiency for Acute ST Segment Elevation Myocardial Infarction in Chest Pain Center_West China Medical Journal

Authors：

 ZhangWei , ZhangQin , ChenYao ,  WanZhi

Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

WanZhi, Email: 303680215@qq.com

Keywords：

Chest Pain Center; Acute ST segment elevation myocardial infarction; Continuous optimization of process; Emergency treatment efficiency

DOI：

10.7507/1002-0179.201600279

Video：

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Objective To explore the effect of continuous improvement of quality control system on the emergency treatment efficiency for patients with acute ST segment elevation myocardial infarction (STEMI) after the establishment of Chest Pain Center. Methods We retrospectively analyzed the differences of theory examination scores acquired by the Chest Pain Center staff one month before and after they got the system training. Moreover, we designated the STEMI patients treated between May and August 2015 after the establishment of Chest Pain Center but before optimization of process to group A (n=70), and patients treated from September to December 2015 after optimization of process to group B (n=55). Then we analyzed the differences between these two groups in terms of the time from patients' arriving to registration, the time from arriving to first order, the length of stay in Emergency Department, and even the time from door to balloon (D2B). Results The scores acquired by Chest Pain Center staff before and after system training were 69.89±6.34 and 87.09±4.39 respectively, with a significant difference (P＜0.05). All the time indicators of both group A and group B were shown as median and quartile. The time from patients' arriving to registration of group A and group B was 6.0 (0.0, 11.0) minutes and 1.0 (0.0, 3.0) minutes (P＜0.05); the time from arriving to first order was 12.8 (9.0, 18.0) minutes and 5.0 (3.0, 9.0) minutes (P＜0.05); the length of stay in Emergency Department was 54.0 (44.0,77.0) minutes and 33.0 (20.0, 61.0) minutes (P＜0.05); and the time of D2B was 107.5 (89.0, 130.0) minutes and 79.0 (63.0, 108.0) minutes (P＜0.05). Conclusion After taking measures such as drawing lessons from the past, training staff and optimizing process continuously, we have significantly shortened the acute STEMI patients' length of stay in the Emergency Department, which has saved more time for the following rescue of STEMI patients.

Citation： ZhangWei, ZhangQin, ChenYao, WanZhi. The Effect of Continuous Improvement of Quality Control Mechanism on the Emergency Treatment Efficiency for Acute ST Segment Elevation Myocardial Infarction in Chest Pain Center. West China Medical Journal, 2016, 31(6): 1038-1041. doi: 10.7507/1002-0179.201600279 Copy

1.	楊雪峰, 于海超, 孟召輝, 等. 急診胸痛中心現狀與未來[J]. 心血管病學進展, 2014, 3(35): 190-193.
2.	候文可, 朱秀彪, 郭江林, 等. 規范胸痛急救流程對高危患者確診時間、輔助檢查應用的影響[J]. 中西醫結合心腦血管病雜志, 2013, 8(11): 1014-1016.
3.	張敏州, 周袁申, 郭力恒. 中醫院胸痛中心建立模式探討[J]. 中國中西醫結合急救雜志, 2013, 20(3): 129-130.
4.	張健, 胡大一, 孫金勇, 等. 急性胸痛患者的病因調查及胸痛中心對胸痛患者診療時間的影響[J]. 臨床心血管病雜志, 2010, 26(8): 618-620.
5.	段寶民, 速錦濤, 李兵. 延遲急診PCI與早期溶栓成功后擇期PCI 對STEMI預后的影響[J]. 中國急救醫學, 2012, 8(32): 692-965.
6.	郭金成, 馬長生, 許敏, 等. 急性ST段抬高心肌梗死患者急診介入治療門-囊時間及其影響因素[J]. 中國介入心臟病學雜志, 2010, 18(1): 21-24.
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8.	張尉華, 孫健, 佟倩, 等. 胸痛患者的區域協同救治體系——中國 “胸痛中心”建設[J]. 中國老年學雜志, 2014, 8(34): 4412-4414.
9.	秦偉毅, 錢洪津, 唐紹輝, 等. 胸痛中心對急性心肌梗死急診介入時間的影響[J]. 中華急診醫學雜志, 2013, 22(10): 1147-1152.
10.	李曉紅, 古勛清, 胡蛟龍. 急性胸痛的病因學構成及就診模式探討[J]. 中國醫藥指南, 2013, 11(11): 415-416.
11.	胡大一. 心血管疾病防治指南和共識2010[M]. 北京: 人民衛生出版社, 2011: 37-61.
12.	江亞. 急診胸痛64例臨床分析[J]. 當代醫學, 2014, 20(8): 37.
13.	陳湘玉, 沈紅, 曹巧蘭, 等. 護理路徑在急診冠狀動脈介入治療綠色通道中的效能初探[J]. 護理研究, 2010, 24(9): 790-792.
14.	Mu?oz D, Roettig ML, Monk L, et al. Transport time and care processes for patients transferred with ST-segment-elevation myocardial infarction: the reperfusion in acute myocardial infarction in Carolina emergency rooms experience[J]. Circ Cardiovasc Interv, 2012, 5(4): 555-562.
15.	宋莉, 顏紅兵, 楊進剛, 等. 不同臨床路徑對ST段抬高心肌梗死患者就診至球囊擴張時間影響的研究[J]. 心肺血管病雜志, 2011, 30(2): 99-102.
16.	蘭艷麗, 朱君. 急診PCI與擇期PCI治療急性心肌梗死的比較研究[J]. 山東醫藥, 2011, 51(52): 87-88.
17.	王建旗. 胸痛中心與綠色通道的發展與模式探索[J]. 中國醫刊, 2014, 49(11): 10-12.
18.	姜玫, 呂明, 段元秀. STEMI 護理工作流程圖在急診PCI術患者中的應用[J]. 齊魯護理雜志, 2014, 20(19): 10-12.
19.	周民偉, 向仕平, 向定成, 等. 胸痛中心信息化與醫療流程優化的實踐[J]. 華南國防醫學雜志, 2013, 27(7): 521-523.
20.	陳湘玉, 沈紅, 曹巧蘭, 等. 護理路徑在急診冠狀動脈介入治療綠色通道中的效能初探[J]. 護理研究, 2010, 24(9): 790-792.
21.	郭瑞威, 楊麗霞, 木麗華. 等繞行急診科對行直接經皮冠狀動脈介入治療患者預后的影響[J]. 中國介入心臟病學雜志, 2015, 11(23): 622-625.

1. 楊雪峰, 于海超, 孟召輝, 等. 急診胸痛中心現狀與未來[J]. 心血管病學進展, 2014, 3(35): 190-193.
2. 候文可, 朱秀彪, 郭江林, 等. 規范胸痛急救流程對高危患者確診時間、輔助檢查應用的影響[J]. 中西醫結合心腦血管病雜志, 2013, 8(11): 1014-1016.
3. 張敏州, 周袁申, 郭力恒. 中醫院胸痛中心建立模式探討[J]. 中國中西醫結合急救雜志, 2013, 20(3): 129-130.
4. 張健, 胡大一, 孫金勇, 等. 急性胸痛患者的病因調查及胸痛中心對胸痛患者診療時間的影響[J]. 臨床心血管病雜志, 2010, 26(8): 618-620.
5. 段寶民, 速錦濤, 李兵. 延遲急診PCI與早期溶栓成功后擇期PCI 對STEMI預后的影響[J]. 中國急救醫學, 2012, 8(32): 692-965.
6. 郭金成, 馬長生, 許敏, 等. 急性ST段抬高心肌梗死患者急診介入治療門-囊時間及其影響因素[J]. 中國介入心臟病學雜志, 2010, 18(1): 21-24.
7. Canadian Cardiovascular Society, American Academy of Family Physicians, American College of Cardiology, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines[J]. Circulation, 2008, 51(2): 210-247.
8. 張尉華, 孫健, 佟倩, 等. 胸痛患者的區域協同救治體系——中國 “胸痛中心”建設[J]. 中國老年學雜志, 2014, 8(34): 4412-4414.
9. 秦偉毅, 錢洪津, 唐紹輝, 等. 胸痛中心對急性心肌梗死急診介入時間的影響[J]. 中華急診醫學雜志, 2013, 22(10): 1147-1152.
10. 李曉紅, 古勛清, 胡蛟龍. 急性胸痛的病因學構成及就診模式探討[J]. 中國醫藥指南, 2013, 11(11): 415-416.
11. 胡大一. 心血管疾病防治指南和共識2010[M]. 北京: 人民衛生出版社, 2011: 37-61.
12. 江亞. 急診胸痛64例臨床分析[J]. 當代醫學, 2014, 20(8): 37.
13. 陳湘玉, 沈紅, 曹巧蘭, 等. 護理路徑在急診冠狀動脈介入治療綠色通道中的效能初探[J]. 護理研究, 2010, 24(9): 790-792.
14. Mu?oz D, Roettig ML, Monk L, et al. Transport time and care processes for patients transferred with ST-segment-elevation myocardial infarction: the reperfusion in acute myocardial infarction in Carolina emergency rooms experience[J]. Circ Cardiovasc Interv, 2012, 5(4): 555-562.
15. 宋莉, 顏紅兵, 楊進剛, 等. 不同臨床路徑對ST段抬高心肌梗死患者就診至球囊擴張時間影響的研究[J]. 心肺血管病雜志, 2011, 30(2): 99-102.
16. 蘭艷麗, 朱君. 急診PCI與擇期PCI治療急性心肌梗死的比較研究[J]. 山東醫藥, 2011, 51(52): 87-88.
17. 王建旗. 胸痛中心與綠色通道的發展與模式探索[J]. 中國醫刊, 2014, 49(11): 10-12.
18. 姜玫, 呂明, 段元秀. STEMI 護理工作流程圖在急診PCI術患者中的應用[J]. 齊魯護理雜志, 2014, 20(19): 10-12.
19. 周民偉, 向仕平, 向定成, 等. 胸痛中心信息化與醫療流程優化的實踐[J]. 華南國防醫學雜志, 2013, 27(7): 521-523.
20. 陳湘玉, 沈紅, 曹巧蘭, 等. 護理路徑在急診冠狀動脈介入治療綠色通道中的效能初探[J]. 護理研究, 2010, 24(9): 790-792.
21. 郭瑞威, 楊麗霞, 木麗華. 等繞行急診科對行直接經皮冠狀動脈介入治療患者預后的影響[J]. 中國介入心臟病學雜志, 2015, 11(23): 622-625.

West China Medical Journal

The Effect of Continuous Improvement of Quality Control Mechanism on the Emergency Treatment Efficiency for Acute ST Segment Elevation Myocardial Infarction in Chest Pain Center

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