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急性心肌梗死合并心源性休克患者ECMO支持下急诊PCI术流程再造

Process Reengineering of Emergency PCI Supported by ECMO in Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock

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目的 基于哈默-流程再造理论优化急性心肌梗死合并心源性休克患者体外膜肺氧合(ECMO)支持下经皮冠状动脉介入术(PCI)救治流程,缩短首次医疗接触-梗死相关动脉开通时间(FMC-To-B).方法 设立流程再造管理团队,梳理原有流程,分析各环节非增值时间占比,制订流程优化方案,包括开发移动PDA,对堆积于急诊科的操作进行前移或后移,构建多学科协作机制,加强救治小组培训,建立多部门协同监管机制.结果 流程再造后,FMC-首份心电图时间、FMC-多学科远程会诊时间、FMC-PCI知情同意时间、FMC-ECMO知情同意时间、FMC-To-B时间均较流程再造前缩短.结论 再造后的救治流程可有效缩短患者FMC-To-B时间,提高医疗质量.
Objective To optimize the treatment process of PCI supported by extracorporeal membrane oxygena-tion(ECMO)in patients with acute myocardial infarction complicated by cardiogenic shock based on the Hammer-process reengineering model,and to shorten the first medical contact to balloon(FMC-To-B).Methods Through the establishment of a process reengineering management team,combing the original process,analyzing the proportion of non-value-added time in each link of the process,formulating process improvement plans,including the develop-ment of mobile PDA,moving forward or moving backward the operations accumulated in the emergency department,es-tablishing a multi-disciplinary collaboration mechanism,strengthening the training of treatment teams,and establis-hing a multi-sectoral collaborative supervision mechanism.Results After the process reengineering,FMC-first ECG time,FMC-multi-disciplinary remote consultation time,FMC-intervention opening time,FMC-ECMO place-ment completion time,FMC-To-B time were shorter than before the process reengineering.Conclusion The re-engineered treatment process can effectively shorten the FMC-To-B time,improve the medical quality.

Acute Myocardial InfarctionCardiogenic ShockExtracorporeal Membrane Oxygenation(ECMO)Percuta-neous Coronary Intervention(PCI)First Medical Contact to Balloon(FMC-To-B)Process ReengineeringMedical Quality

王彦哲、赵静、杨春晓、刘文彩、位新红、郝恩刚、闫春林

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聊城市第二人民医院 山东 聊城 252600

急性心肌梗死 心源性休克 体外膜肺氧合(ECMO) 经皮冠状动脉介入术(PCI) 首次医疗接触-梗死相关动脉开通时间(FMC-To-B) 流程再造 医疗质量

山东省医药卫生科技发展计划项目山东省中医药科技项目

2021030108072021M030

2024

10.13912/j.cnki.chqm.2024.31.10.05

中国卫生质量管理
中国医院协会,陕西省人民医院

中国卫生质量管理

CSTPCD
影响因子：1.091
ISSN：1006-7515
年,卷(期)：2024.31(10)