提升急診「外傷急救小組」啟動的正確性及作業流程之完整性

Improving the Correctness of the “Trauma Blue” Activation Process and the Protocol Integrity of the Trauma Team Operation in the Emergency Department

急診重大外傷病人常因病程發展迅速造成死亡率，亟需立即且完整的外傷急救處置以挽救生命，台灣目前各大醫院急診均有設置包括外科醫師、外科護理人員及護理組長在內的「外傷急救小組」，對到院的重大外傷病人進行評估及急救處置。本院啟動「外傷急救小組」(又稱為「Trauma Blue」)，通常由檢傷護理人員啟動。經調查2008年急診檢傷護理人員因未啟動或誤啟動「外傷急救小組」高達165件，於啟動後其流程執行的完整性僅達76.67%，影響處理重大外傷病人的正確性及時效性。本專案的目的為改善急診啟動「外傷急救小組」的正確性及其流程執行之完整性，使重大外傷病人獲得迅速且完整的照護。專案小組成員透過決策分析，解決方案包括舉辦在職教育並定期評核、改善啟動資訊系統、指定每班外科區護理人員參與外傷急救小組及制定啟動外傷急救小組作業辦法。結果顯示檢傷護理人員對啟動「外傷急救小組」的認知正確性，由改善前的平均68.51分，提升為改善後的平均92.10分，提升23.59%，異常啟動件數比率由2008年的16.82%降至2009年4月30日至2010年5月1日的9.93%，成效顯著；同時，重大外傷病人處置作業完整性，由改善前的76.67%，提升為改善後的92.83%，提升16.16%。本專案結果可提供國內醫療院所對於急診重大外傷病人處置之參考，俾使病人獲得更即時的照護，發揮急診的效益。

The highest mortality rate of major trauma patients in emergency department (ED) is due to the rapid progression in nature, which needs trauma resuscitation management immediately and efficiently. The members of “trauma team” among major hospitals, which usually includes surgeons, surgical nurses, and nursing leaders, are responsible for assessment and necessary emergency treatment for major trauma patients. The “trauma team” also called “Trauma Blue”, is usually activated by triage nurses. The authors found that, there were 165 unnecessary or misjudged “Trauma Blue” activated by triage in 2008. The integrity of the major trauma treatment process was only 76.67%, dramatically impacting the correctness and effectiveness in management of major trauma patients. In order to provide prompt and comprehensive care for major trauma patients in ED, the purpose of the project was to improve the correctness of the activation process and the protocol integrity of the “trauma team”. Through the decision analysis process, the resolutions include in-service education and periodically evaluation, improvement of activation of electronic system, pre-assigned surgical staffs as members of the “trauma team” each shift, and protocol establishment. After the strategies described as above, the knowledge of correctly activating the “trauma team” improved from 68.51 point to 92.10, a 23.59% increase. The frequency of abnormal “trauma team” activation decreased from 16.82% in 2008 to 9.93% from April 30, 2009 to May 1, 2010. The protocol integrity after the “trauma team” activation raised from 76.67% to 92.83%. The outcomes of this project may provide the information regarding how to handle and enhance immediate care effectively for major trauma patients in ED.