The State, Implementation, and Spread of a Nurse Triage SystemSpecialized in Stroke

2010年，我们在全国范围内对具有急性卒中治疗经验的机构进行了一项关于卒中专科护士分诊制度（以下简称卒中护士分诊制度）的问卷调查，以更好地了解该制度的现状。调查期间提出的问题包括手册、教育系统和分诊护士随访系统。接下来，在2011年，我们采访了来自日本四家医院的13名分诊护士，以检验卒中护士分诊系统的效果以及分诊护士的能力、角色和职能要求，并确定该系统的具体问题。我们还参加并观察了卒中分诊现场，并进行了定性和归纳分析。卒中分诊护士制度的实施提高了工作人员的评估能力、手册和教育制度，提高了工作人员的士气。换句话说，实施中风护士分诊制度的次要效果通过访谈变得明显。鉴于2012年修订的医疗支付制度允许收取“医院分诊费”，我们对具有超急性脑卒中治疗经验的医院进行了问卷调查。我们比较了医院分诊收费建立后新实施护士分诊制度的机构（新组）与原来实施护士分诊制度的机构（现有组），以检验卒中分诊制度的特点。与新组相比，现有组对特殊护理的补充医院收费明显更高，有更多专门从事紧急护理的人员，更大的医疗实践和更多的专科护士。与新引入组的医院相比，现有组的医院在指定住院费用、全职人事制度、医疗保健制度和专业护士部署方面的报销明显更多，因此这些医院的中风分诊制度可能更充分发展。因此，新引入组的医院可能在没有适当制度的情况下引入了分诊护士。如果对分诊的评估不充分，可能会延误早期治疗，使患者预后恶化。因此，有必要检查什么样的系统将导致改进的质量分诊护士和提供更好的护理病人。少

In 2010, we performed a nationwide questionnaire survey of facilities with experience in acute stroke treatment regarding the nurse triage system specialized in stroke (hereafter, stroke nurse triage system) to better understand the state of the system. Issues raised during the survey included manuals, education systems, and the triage nurse follow-up system.Next, in 2011, we interviewed a total of 13 triage nurses from four hospitals in Japan inorder to examine the effects of the stroke nurse triage system and required abilities, roles, and functions of triage nurses, and to identify specific issues regarding the system. We also attended and observed a stroke triaging scene, and conducted qualitative and inductive analysis. Implementation of the stroke triage nurse system improved the assessment abilities of staff, manuals and educational systems, and staff morale. In other words, the secondary effects of implementing the stroke nurse triage system became evident through intervews.In … More light of the 2012 revision of the medical payment system that made it possible to charge a “hospital triage fee”, we conducted a questionnaire survey of hospitals with experience in hyper acute stroke treatment. We compared facilities that newly implemented a nurse triage system after establishment of the hospital triage fee (new group) with facilities that originally had such a system (existing group) to examine the characteristics of the stroke triage system. The existing group had significantly higher supplementary hospital charges for special care, more personnel specialized in emergency care, a larger medical practice, and more nurse specialists compared to the new group.Compared to hospitals in the newly-introduced group, hospitals in the existing group had significantly greater reimbursement of specified hospitalization fees, full-time personnel systems, medical care systems, and deployment of specialized nurses, and thus the stroke triage system was likely more fully developed at these hospitalsFor this reason, it is possible that hospitals in the newly-introduced group have introduced triage nurses without an adequate system in place.If the assessment of triage is inadequate, early treatment may be delayed, worsening patient prognosis. Therefore, it is necessary to examine what kind of system will lead to improvements in the quality of triage nurses and the provision of better care to patients. Less