急诊科建设与管理指南(试行)

急诊科建设与管理指南(试行) 急诊科建设与管理指南(试行) 第一章 总则 第一条 为指导和加强医疗机构急诊科的化建设和管理～促进急诊医学的发展～提高急诊医疗水平～保证医疗质量和医疗安全～根据《执业医师法》、《医疗机构管理条例》和《护士条例》等有关法律法规～制定本指南。 第二条 二级以上综合医院急诊科按照本指南建设和管理。 第三条 急诊科是医院急症诊疗的首诊场所～也是社会医疗服务体系的重要组成部分。急诊科实行24小时开放～承担来院急诊患者的紧急诊疗服务～为患者及时获得后续的专科诊疗服务提供支持和保障。 第四条 各级卫生行政部门应当加强对急诊科的指导和监督～医院应当加强急诊科的建设和管理～不断提高急救能力和诊疗水平～保障医疗质量和安全。 第二章 设置与运行 第五条 急诊科应当具备与医院级别、功能和任务相适应的场所、设施、设备、药品和技术力量～以保障急诊工作及时有效开展。 various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once 第六条 急诊科应当设在医院内便于患者迅速到达的区域～并临近大型影像检查等急诊医疗依赖较强的部门。 急诊科入口应当通畅～设有无障碍通道～方便轮椅、平车出入～并设有救护车通道和专用停靠处,有条件的可分设普通急诊患者、危重伤病患者和救护车出入通道。 第七条 急诊科应当设医疗区和支持区。医疗区包括分诊处、就诊室、治疗室、处置室、抢救室和观察室～三级综合医院和有条件的二级综合医院应当设急诊手术室和急诊重症监护室,支持区包括挂号、各类辅助检查部门、药房、收费等部门。 医疗区和支持区应当合理布局～有利于缩短急诊检查和抢救距离半径。 第八条 急诊科应当有醒目的路标和标识～以方便和引导患者就诊～与手术室、重症医学科等相连接的院内紧急救治绿色通道标识应当清楚明显。在医院挂号、化验、药房、收费等窗口应当有抢救患者优先的措施。 第九条 急诊科医疗急救应当与院前急救有效衔接～并与紧急诊疗相关科室的服务保持连续与畅通～保障患者获得连贯医疗的可及性。 第十条 急诊科应当明亮～通风良好～候诊区宽敞～就诊流程便捷通畅～建筑格局和设施应当符合医院感染管理的various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once 要求。儿科急诊应当根据儿童的特点～提供适合患儿的就诊环境。 第十一条 急诊科抢救室应当临近急诊分诊处～根据需要设置相应数量的抢救床～每床净使用面积不少于12平方米。抢救室内应当备有急救药品、器械及心肺复苏、监护等抢救设备～并应当具有必要时施行紧急外科处置的功能。 第十二条 急诊科应当根据急诊患者流量和专业特点设置观察床～收住需要在急诊临时观察的患者～观察床数量根据医院承担的医疗任务和急诊病人量确定。急诊患者留观时间原则上不超过72小时。 第十三条 急诊科应当设有急诊通讯装置,电话、传呼、对讲机,。有条件的医院可建立急诊临床信息系统～为医疗、护理、感染控制、医技、保障和保卫等部门及时提供信息～并逐步实现与卫生行政部门和院前急救信息系统的对接。 第三章 人员配备 第十四条 急诊科应当根据每日就诊人次、病种和急诊科医疗和教学功能等配备医护人员。 第十五条 急诊科应当配备足够数量～受过专门训练～掌握急诊医学的基本理论、基础知识和基本操作技能～具备独立工作能力的医护人员。 various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once 第十六条 急诊科应当有固定的急诊医师～且不少于在岗医师的75%～医师梯队结构合理。 除正在接受住院医师规范化培训的医师外～急诊医师应当具有3年以上临床工作经验～具备独立处理常见急诊病症的基本能力～熟练掌握心肺复苏、气管插管、深静脉穿刺、动脉穿刺、心电复律、呼吸机、血液净化及创伤急救等基本技能～并定期接受急救技能的再培训～再培训间隔时间原则上不超过2年。 第十七条 三级综合医院急诊科主任应由具备急诊医学副高以上专业技术职务任职资格的医师担任。二级综合医院的急诊科主任应当由具备急诊医学中级以上专业技术职务任职资格的医师担任。 急诊科主任负责本科的医疗、教学、科研、预防和行政管理工作～是急诊科诊疗质量、病人安全管理和学科建设的第一责任人。 第十八条 急诊科应当有固定的急诊护士～且不少于在岗护士的75%～护士结构梯队合理。 急诊护士应当具有3年以上临床护理工作经验～经规范化培训合格～掌握急诊、危重症患者的急救护理技能～常见急救操作技术的配合及急诊护理工作内涵与流程～并定期接受急救技能的再培训～再培训间隔时间原则上不超过2年。 various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once 第十九条 三级综合医院急诊科护士长应当由具备主管护师以上任职资格和2年以上急诊临床护理工作经验的护士担任。二级综合医院的急诊科护士长应当由具备护师以上任职资格和1年以上急诊临床护理工作经验的护士担任。 护士长负责本科的护理管理工作～是本科护理质量的第一责任人。 第二十条 急诊科以急诊医师及急诊护士为主～承担各种病人的抢救、鉴别诊断和应急处理。急诊患者较多的医院～还应安排妇产科、儿科、眼科、耳鼻喉科等医师承担本专业的急诊工作。 第二十一条 急诊科可根据实际需要配置行政管理和其他辅助人员。 第四章 科室管理 第二十二条 急诊科应当建立健全并严格遵守执行各项规章、和相关诊疗技术规范、操作规程～保证医疗服务质量及医疗安全。 第二十三条 急诊科应当根据急诊医疗工作制度与诊疗规范的要求～在规定时间内完成急救诊疗工作。急诊实行首诊负责制～不得以任何理由拒绝或推诿急诊患者～对危重急诊患者按照“先及时救治～后补交费用”的原则救治～确保急诊救治及时有效。 various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once 第二十四条 急诊应当制定并严格执行分诊程序及分诊原则～按病人的疾病危险程度进行分诊～对可能危及生命安全的患者应当立即实施抢救。 第二十五条 急诊科要设立针对不同病情急诊病人的停留区域～保证抢救室危重病人生命体征稳定后能及时转出～使其保持足够空间便于应对突来的其他危重病人急救。 第二十六条 急诊科内常备的抢救药品应当定期检查和更换～保证药品在使用有效期内。麻醉药品和精神药品等特殊药品～应按照国家有关规定管理。 第二十七条 急诊科应当对抢救设备进行定期检查和维护～保证设备完好率达到100%～并合理摆放～有序管理。 第二十八条 急诊科医护人员应当按病历书写有关规定书写医疗文书～确保每一位急诊患者都有急诊病历～要记录诊疗的全过程和患者去向。 第二十九条 急诊科应当遵循《医院感染管理办法》及相关法律法规的要求～加强医院感染管理～严格执行预防及手卫生规范～并对特殊感染病人进行隔离。 第三十条 急诊科在实施重大抢救时～特别是在应对突发公共卫生事件或群体灾害事件时～应当按规定及时报告医院相关部门～医院根据情况启动相应的处置程序。 various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once 第三十一条 医院应当加强对急诊科的质量控制和管理～急诊科指定专(兼)职人员负责本科医疗质量和安全管理。 第三十二条 医院及医务管理部门应当指定专,兼,职人员负责急诊科管理～帮助协调紧急情况下各科室、部门的协作～指挥与协调重大抢救和急诊患者分流问。 第三十三条 医院应当制定主要常见急危重症的抢救流程和处置预案～做到急诊科抢救关键措施及相关医技等科室支持配合有章可循。各类辅助检查部门应当按规定时间出具急诊检查报告～药学等部门应当按有关规定优先向急诊患者提供服务。 第三十四条 医院应当建立保证相关人员及时参加急诊抢救和会诊的相关制度。其他科室接到急诊科会诊申请后～应当在规定时间内进行急诊会诊。 第三十五条 医院应当建立急诊病人优先住院的制度与机制～保证急诊处置后需住院治疗的患者能够及时收入相应的病房。 第三十六条 医院应重视对急诊科的安全保卫工作～加强对急诊科的安全巡视～保证急诊科正常工作秩序。 第三十七条 医院应当根据急诊工作的性质和特点～对急诊科医务人员在职称晋升和分配政策方面给予倾斜。 various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once 第五章 检查评估 第三十八条 省级卫生行政部门应当设置急诊医疗质量控制中心对辖区内医疗机构的急诊科进行检查指导与质量评估。 第三十九条 医疗机构应当对卫生行政部门及其委托的急诊医疗质量控制中心开展的对急诊科的检查指导和质量评估予以配合～不得拒绝和阻挠～不得提供虚假材料。 第六章附则 第四十条 开展住院医师规范化培训的地区～急诊医师应当经过规范化培训并考核合格。 第四十一条 承担核辐射及化学中毒等患者救治任务的急诊科～应按照有关规定配备相应防护设备和物品。 第四十二条 纳入院前急救网络并承担院前急救任务的急诊科～还应按规定配备相应的人员、车辆、设备和装置～按院前急救有关规定管理。 第四十三条 设置急诊科的专科医院和其他类别医疗机构参照本指南进行建设和管理。 第四十四条 本指南由卫生部负责解释。 第四十五条 本指南自发布之日起施行。 附件:1. 急诊科仪器设备及药品配置基本标准 various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once 2(急诊医师、护士技术和技能要求 附件1 急诊科仪器设备及药品配置基本标准 一、仪器设备 心电图机、心脏起搏/除颤仪、心脏复苏机、简易呼吸器、呼吸机、心电监护仪、负压吸引器,有中心负压吸引可不配备,、给氧设备,中心供氧的急诊科可配备便携式氧气瓶,、洗胃机。三级综合医院还应配备便携式超声仪和床旁X线机。有需求的医院还可以配备血液净化设备和快速床旁检验设备。 二、急救器械 一般急救搬动、转运器械～各种基本手术器械。 三、抢救室急救药品 心脏复苏药物,呼吸兴奋药,血管活性药、利尿及脱水药,抗心律失常药,镇静药,止痛、解热药,止血药,常见various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once 中毒的解毒药、平喘药、纠正水电解质酸碱失衡类药、各种 静脉补液液体、局部麻醉药、激素类药物等。 various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once 附件2 急诊医师、护士技术和技能要求 一、急诊医师应掌握的技术和技能 ,一,独立处理各种急症,如高热、胸痛、呼吸困难、咯血、休克、急腹症、消化道大出血、黄疸、血尿、抽搐、晕厥、头痛等,的初步诊断和处理原则, ,二,掌握下列心脏病和心率失常心电图诊断:室颤、宽QRS心动过速、房室传导阻滞、严重的心动过缓等, ,三,掌握创伤的初步诊断、处理原则和基本技能, ,四,掌握急性中毒的诊断和救治原则, ,五,掌握暂时未明确诊断急危重症的抢救治疗技能, ,六,能掌握心肺脑复苏术～气道开放技术～电除颤～溶栓术～动、静脉穿刺置管术～心、胸、腹腔穿刺术～腰椎穿刺术～胸腔闭式引流术～三腔管放置术等, ,七,熟练使用呼吸机～多种生理监护仪～快速床旁检验,POCT,技术、血糖、血气快速检测和分析等。 二、急诊护士应掌握的技术和技能 ,一,掌握急诊护理工作内涵及流程～急诊分诊, ,二,掌握急诊科内的医院感染预防与控制原则, ,三,掌握常见危重症的急救护理, ,四,掌握创伤患者的急救护理, various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once ,五,掌握急诊危重症患者的监护技术及急救护理操作技术, ,六,掌握急诊各种抢救设备、物品及药品的应用和管理, ,七,掌握急诊患者心理护理要点及沟通技巧, ,八,掌握突发事件和群伤的急诊急救配合、协调和管理。 various departments (units) to regularly submit activities carried out and dynamic, city will combine grass-roots party construction work in the special supervision, through seminars, site, on-site inspection and other means, timely understanding of the whole market activities, on perfunctory cope with , ineffective work, will be criticized in the city. This year to, XX city fire detachment style clean government work in detachment party and superior discipline of strong led Xia, strongly implement implementation superior strengthening style clean government of decision deployment, strong advance "two a responsibility" implementation, built strong mechanism, strictly practice JI, active adapted new normal, full upgrade "independent Commission against corruption fire" construction level, for advance fire work and forces construction innovation development provides has solid of discipline guarantees. (A) the persistent catch team responsibilities. Low is a team lead. Through regular Party Committee Standing Committee, central group learning, combination of focused learning, self-study, learning relevant An important work of combating corruption and building a spirit. Team lead to be a Standing Committee of the Party Committee study notes, writing tips, and writing topics of the ICAC. Second, Party Committee regularly on the cheap. Clear the discipline inspection and supervision work of grass-roots political Director lead the Brigade units, and established discipline at the grass-roots Party Committee team members team insisted on at least once