การพัฒนาและการใช้รูปแบบการจัดการการบาดเจ็บวิกฤตที่แผนกฉุกเฉิน

Abstract

Critical trauma management at emergency departments (ED) is crucial for patient outcomes. This implementation research aimed to develop a Critical Trauma Management Model at an emergency department and to study its effectiveness on ED management duration and the mortality rates of critical trauma patients. The National Health and Medical Research Council’s Guide to the Development, Implementation and Evaluation of Clinical Practice Guidelines (NHMRC, 1999) was applied as the study framework. The participants were 1) the Critical Trauma Management Model development team, which included one physician and three nurses; 2) the pilot and implementation group, which consisted of six physicians and 14 nurses; and 3) two groups of critical trauma patients, one before and one during the model implementation, composed of 110 patients and 49 patients, respectively. The findings were as follows: 1. The Critical Trauma Management Model for ED was composed of three phases. The first phase, concerning ED preparation for receiving critical trauma patients, involved four aspects, including personnel, facilities, lifesaving equipment, and coordination preparation. The ISBAR communication model was used for information handover. Secondly, the ED critical trauma management phase was comprised of 2 management models: management by a complete team (consisting of two physicians and four nurses) and management by a modified team (consisting of one physician and three nurses), which operated when there were one and two or more trauma patients in the ED, respectively. The third phase involved preparation for ED discharge, in which the ISBAR was used for information handover. 2. The mean of ED management before implementing the model was 74.51 minutes (S.D. 34.77) which decreased to 59.76 minutes (S.D. 26.58) during model implementation. 3. The mortality rate of critical trauma patients before implementing the model was 16.36% which decreased to 6.12% during model implementation. The Critical Trauma Management Model for ED developed in this study was effective for critical trauma management. Emergency departments could apply the model for further quality improvement of critical trauma patient care.