目的：基于我国国情构建科学、简便且高效的眼科急诊预检分诊标准，为眼科医护人员提供高效的眼科急诊预检分诊工具。方法：基于文献查询法、半结构访谈法、德尔菲法及层次分析法确定眼科急诊预检分诊标准内容。通过提取2023年8月1日-2023年8月10日急诊分诊系统及HIMSS电子病历系统数据，分析初次分诊的级别与接诊医生最终诊断的所属级别符合率，对眼科急诊预检分诊标准体系的应用效果进行初步验证。结果：对18名专家进行２轮专家咨询，有效问卷回收率均为100%，专家权威系数均为0.95，肯德尔和谐系数分别为0.5640.117(均P＜0.05)。最终构建的眼科急诊预检分诊标准体系包括3个一级指标、11个二级指标。初步验证显示，该预检分诊标准体系具有92.7%的分诊准确率。结论：本研究构建的眼科急诊预检分诊标准体系结构合理、内容全面，具有科学性及实用性，可为眼科临床急诊预检分诊工作提供准确、有效的分诊工具，有助于提高临床工作效率及预检分诊质量。
Objective: To establish a scientific, simple, and efficient ophthalmic emergency pre-examination triage standard, and provide efficient ophthalmic emergency pre-examination triage tools for ophthalmic staffs, based on national conditions. Methods: With literature search, semi-structured interview, Delphi Method, and Analytic Hierarchy Process, the content of ophthalmic emergency pre-examination and triage standard are confirmed. By extracting data from the emergency triage system and HIMSS electronic medical record system from August 1st, 2023 to August 10th, 2023, the consistency rate between the initial triage level and the final diagnosis level of the attending doctor was analyzed, and the application effect of the ophthalmic emergency pre-examination and triage standard system was preliminarily verified. Results: Two rounds of expert consultation were conducted among 18 experts, all with a 100% effective questionnaire response rate. The expert authority coefficients were 0.95, and the Kendall harmony coefficients were 0.564 and 0.117, respectively (all P<0.05). The final constructed ophthalmic emergency pre-examination triage standard system includes 3 primary indicators and 11 secondary indicators. Through verification, the pre screening triage standard system has a good triage accuracy rate of up to 92.7%. Conclusions: The structure of the ophthalmic emergency pre-examination triage standard system constructed in this study is reasonable, comprehensive, scientific, and practical. It can provide accurate and effective triage tools for ophthalmic clinical emergency pre-examination triage work efficiency, and preexamination triage quality.
随着人口老龄化、生活方式的改变，眼科疾病患病人数的增加、国家眼病诊疗相关政策的持续推动、居民健康意识的逐渐提升，眼科门急诊患者数量持续增长，亟需构建科学的眼科急诊预检分诊标准，合理配置医疗资源，确保患者得到及时、恰当的治疗。国外已有医院依据患者症状或体征的严重程度对患者进行等级划分，建立起相对成熟的眼科急诊预检分诊模式，我国目前尚没有统一的、权威的眼科急诊预检分诊标准，国内外现行的眼科急诊预检分诊模式的分诊精准度及临床适用性有待进一步探索。该文通过综述国内外眼科急诊分诊标准及应用评价、眼科远程急诊预检分诊方式研究进展，以期为构建符合我国国情的、科学有效的眼科急诊预检分诊标准、提高眼科急诊分诊质量提供参考。
With the aging of population, the changing of lifestyle and the increasing number of ophthalmic emergency patients,Chinese national policies related to ophthalmic diagnosis and treatment are continually promoted, and residents' health awareness are gradually improved, the volume of ophthalmic outpatients and emergency patients continues to increase. It is urgent needed to establish scientific ophthalmic emergency pre-examination and triage criteria, to reasonably allocate medical resources, and to ensure that patients receive timely and appropriate treatment. The relatively mature ophthalmic emergency pre-examination and triage models with the severity of patients' symptoms or physical signs,have been established in foreign hospitals. Currently, there is no unified and authoritative ophthalmic emergency triage criteria in China. The accuracy and clinical applicability of the existing ophthalmic emergency triage models at home and abroad need to be further explored. This article reviewed the ophthalmic emergency triage criteria and application evaluation at home and abroad, and remote emergency triage in ophthalmology, in order to provide a reference for establishing a scientific and effective ophthalmic emergency triage criteria comformed Chinese national conditions, and improving the quality of ophthalmic emergency triage.
目的：分析天津市某眼科医院急诊病例疾病谱，为规范疾病诊断流程、合理分配急诊医疗资源提供循证依据。方法 回顾性分析2019年1月~2023年12月在天津市某眼科医院急诊科就诊患者的临床资料，包括一般人口学资料、就诊时间、季节分布及初步诊断等。结果：共纳入26 077例眼科急诊患者，男女比例为1.12∶1，年龄为（36.82±15.44）岁，就诊年龄大多分布在＜14岁（26.74%）及31~40岁（21.03%）；日就诊时间分布中：10:00~12:00（11.06%）、14:00~16:00（10.41%）及20:00~22:00（10.43%）就诊人数较多，05:00~07:00（4.83%）就诊人数较少；4月就诊人数最少（3.87%），8月就诊人数最多（11.61%），夏季就诊人数（31.74%）显著多于其他3个季节；眼科急诊患者最常见的10种初步诊断中结膜炎占比最多（39.58%），其次为干眼症（14.32%）；与2019年相比，2020年和2021年眼科急诊患者前10种初步诊断显著下降（均P<0.001，2020年95%CI为-0.98~-0.68、2021年95%CI为-0.54~-0.11）；与春季相比，其他季节眼科急诊患者前10种初步诊断显著下降（P均<0.001，夏季95%CI为-0.32~-0.08、秋季95%CI为-0.39~-0.14、冬季95%CI为-0.54~-0.30）。其中在结膜炎病例中，与春、夏季相比，冬季结膜炎病例分布呈显著下降趋势（P均<0.001，95%CI分别为-0.08~-0.03]、为-0.08~-0.04）；眼科急诊患者前10种初步诊断性别分布具有统计学意义（P＜0.001）；与14岁以下年龄段相比，其他年龄眼科急诊患者前10种初步诊断均呈下降趋势，（P均<0.001，14~20岁95%CI为-0.88~-0.43、21~30岁95%CI为-1.01~-0.65、31~40岁95%CI为-1.10~-0.82、41~50岁95%CI为-0.97~-0.66、51~60岁95%CI为-1.71~-1.38、61~70岁95%CI为-1.45~-1.08、71~80岁95%CI为-1.36~-0.80、>80岁95%CI为-1.44,-0.22）。结论：眼科急诊患者以儿童和中青年男性为主，14岁以下年龄段人群相比来说有较高风险；日就诊时间分布呈现出“三个高峰一个低谷”的显著特征，就诊高峰时段分别为10:00~12:00、14:00~16:00以及20:00~22:00，就诊低谷出现在05:00~07:00期间；眼科急诊中最常见的诊断主要是那些通常被认为是非紧急的诊断，即结膜炎和干眼症；结膜炎的发病呈现明显的季节性特征，春、夏季为高发期；与2019年相比，2020年和2021年眼科急诊就诊总量显著减少，其中以结膜炎和干眼症的就诊量减少尤为明显，2022年有一定程度的恢复。
Purpose：To analyze the disease spectrum of emergency cases at an ophthalmology hospital in Tianjin, offering evidence-based support for standardizing diagnostic procedures and rationing emergency medical resources. Methods: Reviewed clinical data of patients at the hospital's emergency department from January 2019 to December 2023, covering demographics, visit timings, seasonal distribution, and preliminary diagnoses. Results: A total of 26,077 ophthalmology emergency patients were included, with a male-to-female ratio of 1.12:1 and an average age of 36.82±15.44 years. Most patients were aged <14 years (26.74%) and 31~40 years (21.03%). Daily visits peaked at 10:00~12:00 (11.06%), 14:00~16:00 (10.41%), and 20:00~22:00 (10.43%), and were lowest at 05:00~07:00 (4.83%). April had the fewest visits (3.87%), August the most (11.61%), and summer accounted for the highest quarterly proportion (31.74%). The top 10 preliminary diagnoses were led by conjunctivitis (39.58%) and xerophthalmia (14.32%). Compared to 2019, the top 10 preliminary diagnoses dropped significantly in 2020 and 2021 (both P<0.001), 2020 95%CI[-0.98~-0.68]、2021 95%CI[-0.54~-0.11]. Similarly, these diagnoses were significantly lower in summer, autumn, and winter than in spring (all P<0.001), summer 95%CI[-0.32~-0.08]、autumn 95%CI[-0.39~-0.14]、winter 95%CI[-0.54~-0.30]. In conjunctivitis cases, winter incidence was significantly lower than in spring and summer (both P<0.001). Gender distribution in the top 10 diagnoses was statistically significant (P<0.001), 95%CI[-0.08~-0.03] and [-0.08~-0.04] . Compared to those aged <14, other age groups showed a downward trend in the top 10 preliminary diagnoses (all P<0.001), 14~20 95%CI[-0.88~-0.43]、21~30 95%CI[-1.01~-0.65]、31~40 95%CI[-1.10~-0.82]、41~50 95%CI[-0.97~-0.66]、51~60 95%CI[1.71~-1.38]、61~70 95%CI[-1.45~-1.08]、71~80 95%CI[-1.36~-0.80]、>80 95%CI[-1.44,-0.22].Conclusions: Ophthalmology emergency patients are mainly children and middle-aged men, with those <14 years old at higher risk. Visit times follow a "three-peak-one-valley" pattern. Most diagnoses are non-urgent conditions like conjunctivitis and xerophthalmia. Conjunctivitis shows marked seasonality, peaking in spring and summer. Total ophthalmology emergency visits declined in 2020 and 2021 versus 2019, particularly for conjunctivitis and xerophthalmia, partially recovering in 2022.
目的：探讨眼外伤门诊急诊与住院病房一体化管理模式。方法：中山大学中山眼科中心于2015年4月成立眼外伤急诊部，组建眼外伤急诊队伍，实现眼外伤门诊急诊与住院病房一体化管理，即眼外伤患者从门诊到病房的接诊、治疗、随访进行一体化管理，简化急诊诊疗流程，最大限度保证医疗护理质量。结果：眼外伤门诊急诊与住院病房一体化管理模式是一种以患者为中心的新型管理模式。该模式能保障急诊患者诊治的及时性、连贯性；缩短急诊患者就诊到等候手术的时间，提高患者就诊满意度；在保证医疗质量的同时，医护人力资源得到合理高效使用；并取得较好的社会效益与经济效益。结论：眼外伤门诊急诊与住院病房一体化管理模式具备长远发展及推广的价值。
Objective: To discuss the integrated management in emergency department and wards for patients of ocular trauma. Methods: The emergency department and the team were organized in April 2015 to simplify the process of treatment for patients of ocular trauma, and to improve the benefit and outcome for those patients. Results: The integrated management of emergency department and wards for patients of ocular trauma was a new management model focusing upon the benefit of patients. This model could guarantee the timeliness and continuity by reducing waiting time for diagnosis or operations. The integrated model had obvious economic and social benefits by improving quality of care and reasonably using human resource. Conclusion: TTe integrated management model in emergency department and wards for patients of ocular trauma is worthy of further application.
目的：探讨标准化沟通模式(SBAR)在眼球穿通伤患者护理交班中的应用效果。方法：60例患者作为对照组，使用传统口头方式交班；60例患者作为观察组，使用SBAR沟通模式进行交接。比较两组交班耗时、两组护士对患者病情掌握程度以及患者对护理服务满意度的差异。结果：观察组与对照组比较，上述指标差异具有统计学意义(P<0.05)。结论：采取SBAR沟通模式交班有助于降低在眼球穿通伤护理中的不良事件发生率，保障了护理质量，提高了交接班效率和患者满意度，适宜推广应用。
Objective: To evaluate the SBAR communication model in the nursing care handover of patients with penetration injuries of eyeball. Methods: Transfer time, receivers’ information retention, and patient’s satisfaction were compared between two groups of patients with penetration injuries of eyeball. A total of 60 patients were handled with the traditional oral communication handover as comparison group and other 60 patients were handled with the SBAR handover as intervention group. Results: When comparing intervention group with comparison group, statistically significant improvements (P<0.05) were observed in all three factors tested. Conclusion:Implementing the communication tool SBAR in the nursing care of patients with penetration injuries of eyeball reduces rate of adverse events, improves patient care quality, enhances transfer efficiency, and boosts patient’s satisfaction.
目的：探索基于眼外伤急诊救治胜任力的教学模式。方法：通过分析眼外伤急诊救治的教学现状，结合医学生岗位胜任力特征，构建基于眼外伤急诊救治胜任力的教学体系。结果：基于胜任力构建的眼外伤急诊救治教学体系的优势在于一切以临床实际需求为出发点，使学生在临床实践能力、思辨能力、团队合作、自我认知、医学人文素养等几个方面得到提升，从而更好地胜任临床工作。结论：基于胜任力的教学模式可以全面提高培训医师眼外伤急诊救治的实际能力。
Objective: To explore the teaching mode based on competency in emergency treatment of ocular trauma.Methods: By analyzing the teaching status of emergency treatment for ocular trauma and combining with the competency characteristics of medical students, a competency-based teaching system for emergency treatment of ocular trauma was constructed. Results: The advantage of the teaching system for emergency treatment of ocular trauma based on competency was that it took actual clinical needs as the starting point, which could improve students’ clinical practice ability, critical thinking ability, team work, self-cognition, medical humanistic quality and other aspects, so as to be better qualified for clinical work. Conclusion: The teaching mode based on competency can comprehensively improve the practical ability of training doctors in emergency treatment of ocular trauma.
