跨界合作縮短急診心肌梗塞病人至心導管室時間

Cross-Border Collaboration to Reduce the Door-to-Wire Time for Patients with Myocardial Infarction

歐洲心臟協會指出，心肌梗塞患者施行緊急冠狀動脈介入術時，再灌流時間應小於90分鐘，此亦為醫院緊急醫療能力分級指標，本院達成率僅82%，引發改善動機。經觀察分析找出無專人施作心電圖、心導管術前準備不熟悉、檢傷未辨別出恐為心肌梗塞病患、心臟科會診超時、無心導管醫囑套餐等問題，透過製作STEMI病人小包及查檢表、建立醫囑套餐、跨界與消防局合作組成Line群組，執行到院前心電圖線上判讀等改善策略，急診停留時間由55分鐘縮為45分鐘，再灌流時間從83分鐘降至75分鐘，小於90分鐘比率提升至90.9%。經改善方案及跨界合作，體現以病人為中心的全人醫療，給予更完善的照護，提升醫療品質，盼能提供其他醫療單位參考。

The European Society of Cardiology stipulates that the reperfusion time for patients with myocardial infarction undergoing emergency coronary intervention should be less than 90 minutes. This also serves as an indicator of a hospital’s emergency medical capability. The aforementioned reperfusion time of the hospital investigated by the researcher of this study was merely 82%, which sparked the motivation for improvement. Upon observations and analyses, the following problems were identified: the lack of dedicated personnel for conducting electrocardiograms, unfamiliarity with pre-catheterization preparations, failure to identify potential patients with myocardial infarction during triage, delayed cardiology consultations, and the absence of a standard medical order set for catheterization. By implementing improvement strategies such as creating a small package and checklist for patients with ST-segment elevation myocardial infarction, establishing a medical order set, and collaborating with the fire department to form a LINE group for pre-hospital online electrocardiogram interpretation, the emergency department stay was reduced from 55 to 45 minutes, and reperfusion time was decreased from 83 to 75 minutes, and the rate of achieving reperfusion in under 90 minutes increased to 90.9%. Through these improvements and cross-domain collaboration, patient-centered holistic medical care was exemplified, and the quality of care was enhanced. The results of this study may server as references for other medical units.