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            天氣預報: 密云區氣象臺4月23日7時發布天氣預報: 今天白天:晴轉多云,早晨有輕霧,偏南風2、3間4級,最高氣溫28℃; 今天夜間:多云轉陰,有小雨,南轉東風2、3級,最低氣溫13℃。 氣溫回升明顯,晝夜溫差較大,出行請注意適時增減衣物。
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            20家三甲醫院5月“急診分級” 病情危重患者優先救治

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            【來源】: 首都之窗 【發布時間】: 2019-04-23 10:27 

              原標題:按病情輕重緩急分為四級,確保病情危重患者優先得到救治 20家三甲醫院下月“急診分級”

              很快,本市醫院急診科將打破過去患者“先來后到”的看病順序,而是按病情輕重緩急將患者分為四級,以確保病情危重的患者優先得到救治,而病情不太緊急的患者,掛急診號很可能會等待很長的時間。從北京市醫院管理局獲悉,2019年5月1日起,20家提供急診服務的北京市屬三甲醫院,將統一實施急診預檢分診分級就診(簡稱“急診分級”)。

              大醫院“急診不急”成常態

              醫院急診科是搶救急危重癥患者的場所,承擔著24小時不間斷的緊急醫療救治任務。近年來,隨著我國急診醫學進入快速發展時期,三級醫院急診量逐年增長。目前,本市市屬三級醫院的年急診量已達235萬人次。而造成就醫人數攀升、環境擁擠的原因之一,就是大量的非急診患者占用了有限的急診資源。有調查顯示,在急診就診的患者中,非急癥患者比例大約占30%到50%,甚至有個別的醫療機構高達80%。

              北京市醫管局醫療護理處相關負責人表示,每一個前往急診的患者,都希望自己第一時間得到救治,也因此導致大醫院“急診不急”的現象較為普遍。這一現狀在很大程度上影響了急危重癥患者的搶救。“這就像高速路上的應急車道,被搶時間的私家車占用,當真的出現緊急狀況時,這條生命之路可能已經被堵死。”

              “當前,醫院亟待提高急診的‘準入門檻’,實行‘分級而定’的科學甄別和合理區分,并最終達到有效分流患者的目的。”該負責人說,“我們希望把有限的急診醫療資源最大限度地用在急危重癥患者的搶救上,進一步提高急診救治效率。”

              按病情分四級 急重癥優先看

              急診預檢分診是根據患者的癥狀和體征,區分病情的輕重緩急及隸屬專科,進行初步診斷、安排救治的過程。急診預檢分診是急診就診的首要環節,安全有效的急診預檢分診可準確識別急危重癥患者,確保患者安全,提高急診運行效率。

              市醫管局此次明確提出,在本市提供急診服務的20家市屬三甲醫院,統一開展急診預檢分診分級就診,并將患者分為“瀕危、危重、急癥和非急癥”1-4級分級管理,遵循從重到輕、從病情迅速變化到相對穩定的原則,合理安排患者就診順序,優先處理較重病人。有條件的醫院應盡量安排各級別患者的就診通道和救治區域互不干擾、分區管理。

              其中,1級患者病情瀕危、隨時可能危及生命,如出現心跳呼吸驟停、休克、明確的心肌梗死、癲癇持續狀態等癥狀,將即刻進入復蘇室或搶救室進行搶救;2級患者病情危重或迅速惡化、存在生命危險,如嚴重呼吸困難、昏睡、急性腦卒中、ECG提示急性心肌梗死、活動性或嚴重失血等,一般會在10分鐘內進入搶救室進行救治;3級患者病情急、存在潛在的生命威脅,如急性哮喘、吸入異物、吞咽困難、持續嘔吐、胸腹痛、輕中度外傷、輕中度出血等,將先于4級非急癥患者優先診治,候診時間大約30分鐘左右;4級患者為非急癥,病情程度一般,如無危險特征的輕微疼痛、不需要縫合的小的擦傷、穩定恢復期患者復診、僅開具醫療證明等情況。這類患者將根據指引順序就診,等候時間較長。

              “急診科最重要的環節就是預檢分診。”朝陽醫院急診科主任郭樹彬稱,朝陽醫院每天的急診量在500—600人次,高峰時高達700人次。如果醫院不能將患者有效分診,那么患者在等候就診過程中就會有可能發生生命危險。“進入不同區域候診,搶救的及時性就會有所不同,這將直接影響著患者的預后情況。”

              專人動態評估候診者病情

              急診科實行“急診分級”就診,很多患者可能會心存疑問:醫院如何保證分級的科學、公平和安全?

              對此,市醫管局推出了“三重保障”以確保每位患者的利益。第一重保障為經驗豐富的專業分診醫務人員,各醫院急診科將分別安排經驗豐富的人員從事急診預檢分診工作,并組織急診相關的所有醫務人員,進行了全員專項培訓;第二重保障是專業儀器采集生命體征,具體包括心率、血壓、血氧飽和度等,同時醫務人員會結合患者的病史、癥狀、體征,做出最終科學的分級及隸屬專科。第三重保障則是專業人員監測候診區患者病情。對于3級、4級患者,在候診區等候時,會有專門的醫務人員定期進行巡視,對候診患者的病情及潛在的危險動態評估,可根據最新的評估情況再次調整分級,保證患者生命安全。患者如有突發不適,也請及時告知醫務人員,以便及時采取相應的醫療護理措施。

              那么,4級急診患者究竟要等待多長時間?

              市醫管局相關負責人表示,盡管各醫院分診臺的護士會根據當時患者的候診情況進行大致估算,但4級急診患者的等候時間確實并不太容易確定,等候兩三個小時甚至更長時間也是有可能的。因為各醫院的具體情況不同,且每一天接診患者的情況也有所不同,而兒科則因醫生緊缺等原因,等候時間可能會更長。原則上,我們還是希望得到社會大眾的支持和理解,建議非急癥患者盡量選擇到門診就診,把有限的急診資源留給真正有需要的急危重癥患者。(劉歡 馬君寧)

              鏈接

              20家市屬醫院名單

              首都醫科大學附屬北京友誼醫院

              首都醫科大學附屬北京同仁醫院

              首都醫科大學附屬北京朝陽醫院

              北京積水潭醫院

              首都醫科大學附屬北京天壇醫院

              首都醫科大學附屬北京安貞醫院

              首都醫科大學附屬北京世紀壇醫院

              首都醫科大學宣武醫院

              北京清華長庚醫院

              首都醫科大學附屬北京中醫醫院

              首都醫科大學附屬北京兒童醫院

              首都兒科研究所附屬兒童醫院

              首都醫科大學附屬北京婦產醫院

              首都醫科大學附屬北京胸科醫院

              首都醫科大學附屬北京口腔醫院

              首都醫科大學附屬北京佑安醫院

              首都醫科大學附屬北京地壇醫院

              首都醫科大學附屬北京安定醫院

              北京回龍觀醫院

              北京老年醫院

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