| 中文摘要 |
背景：心導管的介入時間對ST上升型急性心肌梗塞（ST-elevation myocardial infarction, STEMI）病人至關重要，延遲會影響治療效果，因此需跨團隊及跨科別合作；現況分析顯示有六成以上的STEMI病人是經由緊急醫療服務網（emergency medical services）轉送，從救護車至心導管介入前之總平均耗時為127分55秒，到院至血管重新灌流（door-to-wire, D2W）時間為108分25秒。
目的：急診經緊急醫療服務網轉送的STEMI病人，D2W時間縮短至90分鐘內。
解決方案藉由修訂評估治療流程、建立跨團隊通訊群組、宣導院前心電圖重要性、回饋病人結果、增設STEMI常用藥、縮短等候電梯時間、建立心導管術前醫療處置時間表與評核機制，進而縮短心導管介入之時間。
結果：經方案改善後，D2W平均時間由108分25秒縮短至33分40秒，達成專案目標。
結 論建議未來縮短心導管介入時間，應整合跨團隊並加強院前功能。 |
| 英文摘要 |
Background & Problems: Time of catheterization is a critical variable for patients with ST-elevation myocardial infarction (STEMI), as delays can adversely impact treatment outcomes. Therefore, collaboration across care teams and medical disciplines is necessary to support optimal care outcomes. An analysis found that Emergency Medical Services is used to transfer over 60% of STEMI patients in our hospital; average total time from ambulance arrival to catheterization is 127 minutes and 55 seconds; and average door-to-wire (D2W) time is 108 minutes and 25 seconds.
Purpose: This project was developed to shorten the D2W time for STEMI patients transferred to the emergency department via Emergency Medical Services to under 90 minutes.
Resolution: To shorten the catheterization intervention time, several measures were implemented. The treatment process assessment was revised, a cross-team messaging group was established, the importance of pre-hospital electrocardiograms was promoted, feedback on patient outcomes was provided, commonly used STEMI medication availability was increased, elevator waiting time was reduced, and a pre-catheterization medical procedure timeline and evaluation mechanism were created.
Results: After the implementation of all of the measures, the average D2W time was reduced from 108 minutes and 25 seconds to 33 minutes and 40 seconds.
Conclusions: Based on the results of this project, future efforts to shorten catheterization intervention time should focus on integrating interdisciplinary teams and enhancing pre-hospital functions. |
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