優化急性冠心症病人急診照護流程

Optimization of Emergency Care Process for Patients with Acute Coronary Syndrome

急性冠心症發作突然且危及生命，即刻疏通恢復血流是刻不容緩。為縮短病人到達急診後至心導管時間，故優化急診照護流程，以提升醫療品質。經現況分析發現STEMI（ST Elevation Myocardial Infarction）病人，非轉院之病人由掛號至導絲通過病灶總時間於90分鐘內完成，達成率93%，外院轉診至本院之病人總時間於60分鐘內完成處置，達成率80%。主要問題為人員未發揮檢傷組長角色、開立之同意書未交付專責護理師、找不到家屬等因素。安排教育訓練、制定執行心電圖適應症及優先順序與氧氣筒使用原則等措施。結果顯示非轉院時間小於90分鐘，達成率由93%提升至95%；轉院時間小於60分鐘，達成率由80%提升至90%，達專案目標。透過宣導及多項措施，有效優化急性冠心症病人急診照護流程，並提供其他醫學中心照護之參考。

Acute coronary syndrome (ACS) is a sudden and life-threatening condition that requires immediate restoration of blood flow. It is crucial to expedite the time from patient arrival at the emergency department to coronary intervention. To enhance the quality of care, the emergency care process for ACS patients has been optimized. Current analysis revealed that in ST-elevation myocardial infarction (STEMI) patients, the door-to-wire (D to W) time, which refers to the time from arrival to wire crossing, was less than 90 minutes with an achievement rate of 93%. The transfer time was less than 60 minutes with an achievement rate of 80%. The main issues identified included failure of staff to fulfill the role of triage team leader, non-delivery of consent forms to dedicated nurses, and difficulty in locating family members. Measures were implemented, including education and training, development of appropriate indications for electrocardiogram (ECG), prioritization, and principles of oxygen cylinder usage. The results showed an improvement in the achievement rate of D to W time, increasing from 93% to 95%, and the achievement rate of transfer time improving from 80% to 90%, thus achieving the project objectives. Through promotion and various measures, the emergency care process for patients with acute coronary syndrome has been effectively optimized, providing a reference for care in other medical centers.