Yang Yuying, Chang Qing, Chen Jing, Zou Xiangkun, Xue Qian, Song Aixia
Stroke Center Office, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China.
Department of Neurology, The First Affiliated Hospital of Hebei North University, Zhangjiakou, China.
Front Surg. 2022 Apr 5;9:874577. doi: 10.3389/fsurg.2022.874577. eCollection 2022.
To explore the application value of an integrated emergency care model based on failure modes and effects analysis (FMEA) in patients with acute ischemic stroke (AIS).
According to the convenience sampling method, 100 patients with AIS who visited the emergency department in our hospital from October 2018 to March 2019 were randomly selected as the control group and received routine emergency care mode intervention. Another 100 AIS patients who visited the emergency department from April to October 2019 were selected as the intervention group and received the integrated emergency care model based on FMEA. The total time spent from admission to completion of each emergency procedure [total time spent from admission to emergency physician reception (T), total time spent from admission to stroke team reception (T), total time spent from admission to imaging report out (T), total time spent from admission to laboratory report out (T), and total time spent from admission to intravenous thrombolysis (T)] was recorded for both groups. The clinical outcome indicators (vascular recanalization rate, symptomatic intracerebral hemorrhage incidence, mortality rate) were observed for both groups. The National Institutes of Health Stroke Scale (NIHSS) score and Barthel score were evaluated for both groups after the intervention. The treatment satisfaction rate of the patients was investigated for both groups.
The total time of T, T, T, T, T in the intervention group (0.55 ± 0.15, 1.23 ± 0.30, 21.24 ± 3.01, 33.30 ± 5.28, 44.19 ± 7.02) min was shorter than that of the control group (1.22 ± 0.28, 4.01 ± 1.06, 34.12 ± 4.44, 72.48 ± 8.27, 80.31 ± 9.22) min ( < 0.05). The vascular recanalization rate in the intervention group (23.00%) was higher than that in the control group (12.00%) ( < 0.05). There was no statistical significance in the symptomatic intracerebral hemorrhage incidence and mortality rate in the two groups ( > 0.05). After intervention, the NIHSS score of the intervention group (2.95 ± 0.91) was lower than that of the control group (6.10 ± 2.02), and the Barthel score (77.58 ± 7.33) was higher than that of the control group (53.34 ± 5.12) ( < 0.05). The treatment satisfaction rate in the intervention group (95.00%) was higher than that of the control group (86.00%) ( < 0.05).
Through FMEA, the failure mode that affects the emergency time of AIS patients is effectively analyzed and the targeted optimization process is proposed, which are important to enhance the efficiency and success rate of resuscitation of medical and nursing staff and improve the prognosis and life ability of patients.
探讨基于失效模式与效应分析（FMEA）的一体化急救模式在急性缺血性脑卒中（AIS）患者中的应用价值。
采用便利抽样法，将2018年10月至2019年3月在我院急诊科就诊的100例AIS患者随机选为对照组，接受常规急救模式干预。将2019年4月至10月在急诊科就诊的另外100例AIS患者选为干预组，接受基于FMEA的一体化急救模式。记录两组从入院到完成各项急救流程的总时间[从入院到急诊医师接诊的总时间（T）、从入院到卒中团队接诊的总时间（T）、从入院到影像报告出具的总时间（T）、从入院到实验室报告出具的总时间（T）、从入院到静脉溶栓的总时间（T）]。观察两组的临床结局指标（血管再通率、症状性脑出血发生率、死亡率）。干预后评估两组的美国国立卫生研究院卒中量表（NIHSS）评分和Barthel评分。调查两组患者的治疗满意率。
干预组的T、T、T、T、T总时间（0.55±0.15、1.23±0.30、21.24±3.01、33.30±5.28、44.19±7.02）分钟短于对照组（1.22±0.28、4.01±1.06、34.12±4.44、72.48±8.27、80.31±9.22）分钟（<0.05）。干预组的血管再通率（23.00%）高于对照组（12.00%）（<0.05）。两组的症状性脑出血发生率和死亡率无统计学意义（>0.0５）。干预后，干预组的NIHSS评分（2.95±0.91）低于对照组（6.10±2.０2），Barthel评分（77.58±7.33）高于对照组（53.34±5.12）（<0.05）。干预组的治疗满意率（95.00%）高于对照组（86.00%）（<0.05）。
通过FMEA，有效分析了影响AIS患者急救时间的失效模式并提出针对性优化流程，对提高医护人员抢救效率及成功率、改善患者预后及生活能力具有重要意义｡
