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.	杨雪峰, 于海超, 孟召辉, 等. 急诊胸痛中心现状与未来[J]. 心血管病学进展, 2014, 3(35): 190-193.
2.	候文可, 朱秀彪, 郭江林, 等. 规范胸痛急救流程对高危患者确诊时间、辅助检查应用的影响[J]. 中西医结合心脑血管病杂志, 2013, 8(11): 1014-1016.
3.	张敏州, 周袁申, 郭力恒. 中医院胸痛中心建立模式探讨[J]. 中国中西医结合急救杂志, 2013, 20(3): 129-130.
4.	张健, 胡大一, 孙金勇, 等. 急性胸痛患者的病因调查及胸痛中心对胸痛患者诊疗时间的影响[J]. 临床心血管病杂志, 2010, 26(8): 618-620.
5.	段宝民, 速锦涛, 李兵. 延迟急诊PCI与早期溶栓成功后择期PCI 对STEMI预后的影响[J]. 中国急救医学, 2012, 8(32): 692-965.
6.	郭金成, 马长生, 许敏, 等. 急性ST段抬高心肌梗死患者急诊介入治疗门-囊时间及其影响因素[J]. 中国介入心脏病学杂志, 2010, 18(1): 21-24.
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9.	秦伟毅, 钱洪津, 唐绍辉, 等. 胸痛中心对急性心肌梗死急诊介入时间的影响[J]. 中华急诊医学杂志, 2013, 22(10): 1147-1152.
10.	李晓红, 古勋清, 胡蛟龙. 急性胸痛的病因学构成及就诊模式探讨[J]. 中国医药指南, 2013, 11(11): 415-416.
11.	胡大一. 心血管疾病防治指南和共识2010[M]. 北京: 人民卫生出版社, 2011: 37-61.
12.	江亚. 急诊胸痛64例临床分析[J]. 当代医学, 2014, 20(8): 37.
13.	陈湘玉, 沈红, 曹巧兰, 等. 护理路径在急诊冠状动脉介入治疗绿色通道中的效能初探[J]. 护理研究, 2010, 24(9): 790-792.
14.	Muñoz 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, 颜红兵, 杨进刚, 等. 不同临床路径对ST段抬高心肌梗死患者就诊至球囊扩张时间影响的研究[J]. 心肺血管病杂志, 2011, 30(2): 99-102.
16.	兰艳丽, 朱君. 急诊PCI与择期PCI治疗急性心肌梗死的比较研究[J]. 山东医药, 2011, 51(52): 87-88.
17.	王建旗. 胸痛中心与绿色通道的发展与模式探索[J]. 中国医刊, 2014, 49(11): 10-12.
18.	姜玫, 吕明, 段元秀. STEMI 护理工作流程图在急诊PCI术患者中的应用[J]. 齐鲁护理杂志, 2014, 20(19): 10-12.
19.	周民伟, 向仕平, 向定成, 等. 胸痛中心信息化与医疗流程优化的实践[J]. 华南国防医学杂志, 2013, 27(7): 521-523.
20.	陈湘玉, 沈红, 曹巧兰, 等. 护理路径在急诊冠状动脉介入治疗绿色通道中的效能初探[J]. 护理研究, 2010, 24(9): 790-792.
21.	郭瑞威, 杨丽霞, 木丽华. 等绕行急诊科对行直接经皮冠状动脉介入治疗患者预后的影响[J]. 中国介入心脏病学杂志, 2015, 11(23): 622-625.

1. 杨雪峰, 于海超, 孟召辉, 等. 急诊胸痛中心现状与未来[J]. 心血管病学进展, 2014, 3(35): 190-193.
2. 候文可, 朱秀彪, 郭江林, 等. 规范胸痛急救流程对高危患者确诊时间、辅助检查应用的影响[J]. 中西医结合心脑血管病杂志, 2013, 8(11): 1014-1016.
3. 张敏州, 周袁申, 郭力恒. 中医院胸痛中心建立模式探讨[J]. 中国中西医结合急救杂志, 2013, 20(3): 129-130.
4. 张健, 胡大一, 孙金勇, 等. 急性胸痛患者的病因调查及胸痛中心对胸痛患者诊疗时间的影响[J]. 临床心血管病杂志, 2010, 26(8): 618-620.
5. 段宝民, 速锦涛, 李兵. 延迟急诊PCI与早期溶栓成功后择期PCI 对STEMI预后的影响[J]. 中国急救医学, 2012, 8(32): 692-965.
6. 郭金成, 马长生, 许敏, 等. 急性ST段抬高心肌梗死患者急诊介入治疗门-囊时间及其影响因素[J]. 中国介入心脏病学杂志, 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. 张尉华, 孙健, 佟倩, 等. 胸痛患者的区域协同救治体系——中国 “胸痛中心”建设[J]. 中国老年学杂志, 2014, 8(34): 4412-4414.
9. 秦伟毅, 钱洪津, 唐绍辉, 等. 胸痛中心对急性心肌梗死急诊介入时间的影响[J]. 中华急诊医学杂志, 2013, 22(10): 1147-1152.
10. 李晓红, 古勋清, 胡蛟龙. 急性胸痛的病因学构成及就诊模式探讨[J]. 中国医药指南, 2013, 11(11): 415-416.
11. 胡大一. 心血管疾病防治指南和共识2010[M]. 北京: 人民卫生出版社, 2011: 37-61.
12. 江亚. 急诊胸痛64例临床分析[J]. 当代医学, 2014, 20(8): 37.
13. 陈湘玉, 沈红, 曹巧兰, 等. 护理路径在急诊冠状动脉介入治疗绿色通道中的效能初探[J]. 护理研究, 2010, 24(9): 790-792.
14. Muñoz 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, 颜红兵, 杨进刚, 等. 不同临床路径对ST段抬高心肌梗死患者就诊至球囊扩张时间影响的研究[J]. 心肺血管病杂志, 2011, 30(2): 99-102.
16. 兰艳丽, 朱君. 急诊PCI与择期PCI治疗急性心肌梗死的比较研究[J]. 山东医药, 2011, 51(52): 87-88.
17. 王建旗. 胸痛中心与绿色通道的发展与模式探索[J]. 中国医刊, 2014, 49(11): 10-12.
18. 姜玫, 吕明, 段元秀. STEMI 护理工作流程图在急诊PCI术患者中的应用[J]. 齐鲁护理杂志, 2014, 20(19): 10-12.
19. 周民伟, 向仕平, 向定成, 等. 胸痛中心信息化与医疗流程优化的实践[J]. 华南国防医学杂志, 2013, 27(7): 521-523.
20. 陈湘玉, 沈红, 曹巧兰, 等. 护理路径在急诊冠状动脉介入治疗绿色通道中的效能初探[J]. 护理研究, 2010, 24(9): 790-792.
21. 郭瑞威, 杨丽霞, 木丽华. 等绕行急诊科对行直接经皮冠状动脉介入治疗患者预后的影响[J]. 中国介入心脏病学杂志, 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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