以跨團隊合作縮短STEMI病人接受心導管治療術時間

Utilizing Team Cooperation to Shorten the Time in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

根據中華民國心臟學會治療指引，冠狀動脈氣球擴張術需在90分鐘內完成，但本院完成時間長達129分鐘，引發專案改善動機。資料分析後發現醫護人員術前準備作業時間長、病人家屬對治療不確定感、缺乏統合跨團隊合作等問題。改善策略包括：舉辦護理作業相關說明會、張貼檢傷級數及處置流程圖海報、電腦系統提示及重症區床位規劃、制定術前醫護處置流程查核表、提供多媒體衛教資訊、建立心臟內科值班醫師二線會診機制等。改善後急診心導管術前準備時間縮短到46分鐘，冠狀動脈氣球擴張術完成總時間74分鐘。專案確實縮短ST段上升急性心肌梗塞病人接受心導管時間，結果可供其他醫院參考。

According to the guideline of ST-segment elevation myocardial infarction by Taiwan society of cardiology association, primary percutaneous coronary intervention (PCI) should be completed within 90 minutes after symptom onset. In our hospital, it took an average of 129 minutes to be completed. We therefore developed this project to shorten the time from door to balloon. The situational analysis revealed that the delay was mainly in the preparation for PCI, waiting for the final decision of to be made by the patient or family, and lack of team cooperation. Strategies for this project included providing nurses in-service education, setting flowchart posters, adding reminder alarm in computer system, critical care patient relocation, developing new checklists, offering multimedia information to patient and family, and establishing the first and second-call cardiologist consultation system. The project has shortened first stage preparation to 46 minutes, and door to balloon time from 129 to 74 minutes. In this article we shared our experience for future reference for other hospitals.