急性缺血性腦中風病患急診就醫流程改善方案

An Improvement Project on the Emergency Medical Flowchart for Acute Ischemic Stroke Patients

急性缺血性腦中風病患若能在黃金搶救時間三小時內完成緊急處置，將可減少不可逆的腦組織損傷。本專案小組收集2005年1月至6月疑似急性缺血性腦中風病患共505名，其中發病後在四小時內能趕到急診治療者僅57名，且符合美國國衛院訂定的於二小時內能完成就醫流程者僅26名（46%），分析其原因為缺乏跨部門的溝通機制、缺乏腦中風病患急診就醫標準作業流程、急診醫師開立照會時間太晚、等待神經專科醫師會診時間過長、以及等待相關檢驗及檢查報告時間太久導致延遲完成急診就醫流程。本專案藉由成立「腦中風治療行動小組」，於會中共同制定「急診急性缺血性腦中風病患治療流程」、「檢傷啟動快速照會流程」、規範「神經專科醫師照會準則」、以及「檢查檢驗快速送檢流程」，經宣導及執行改善後，結果顯示神經專科醫師會診時間由原26分鐘降為7分鐘；完成腦部電腦斷層原花費42分鐘，到流程改善後只需26分鐘；確立診斷也由專案實施前的54分鐘，改善後降為26分鐘；病患於二小時內能完成急診就醫流程者由46%提升至98%，達本專案目標。此外，建議政府相關單位應加強教育民眾急性缺血性腦中風的知識及緊急就醫觀念，於黃金搶救時間內抵達急診，以得到最快速有效的診治。Emergent treatment of a patient with a stroke within first 3 hours can reduce irreversible brain damages. In this project, the data on 505 patients who were suspected of acute ischemic stroke were collected from January to June 2005. 57 patients were presented to ED within 4 hours after their attack, and only 26 of them (46%) completed the acute stroke guidelines from the American National Health Institute. The reasons of delayed treatment beyond 2 hours were: 1. lack of the communication between different departments; 2. lack of a standard medical flowchart for the stroke patients to follow; 3. delayed consultation of neurologists; 4. long wait for the neurological consultants; and 5. long wait for the lab data. This improvement project proposed to avoid this delay by setting up 'Acute Ischemic Stroke Action Team', 'Flowchart for Acute Ischemic Stroke Patient in ED', 'Triage Activate Consultation' and 'Rapid Examination Flowchart'. The results after the flowchart applied are: the consultation time was decreased from 26 minutes to 7 minutes; the interval of brain CT scan was decreased from 42 minutes to 26 minutes; the time for confirmation of diagnosis was decreased from 54 minutes to 26 minutes; the rate of accomplishing the new flowchart within 2 hours was increased from 46% to 98%. Therefore, the project succeeded to improve the flow of stroke treatment. In addition, education on the knowledge of acute ischemic stroke and emergency medical care in the 'golden salvage time' to general population should be reinforced to help acute ischemic stroke patients get the appropriate and efficient care.