| ObjectivesTo card the treatment process of acute ischemic stroke and inquire into the interfering factors of in-hospital delay;Discrete event simulation model of in-hospital delay among acute ischemic stroke was build and the optimization scheme of in-hospital delay by designing simulation experiments.Methods1.First of all,by using the method of cross-sectional survey,patients with acute ischemic stroke in the emergency of one hospitals in Qingdao from September 2021 to January 2022 were investigated by questionnaire on treatment in emergency.The data were analyzed by SPSS software.The demographic data of patients was described by the frequency and composition ratio;the influence of general demographic data and emergency admission were used to determine by Chi-square analysis and logistic regression analysis;the time of emergency treatment was compared by nonparametric rank sum test;the relationship between the characteristics of emergency nurses and the queuing time of stroke patients was analyzed by linear regression.2.The discrete event simulation model was built by using the Anylogic platform,simulation experiments are designed according to the different queuing schemes of patients with acute ischemic stroke and allocation schemes of emergency nurses on the basis of the cross-sectional survey data.The simulation was carried out with the help of the model to verify the effectiveness of the model.The simulation results were obtained and suggestions for improving the hospital delay of patients were put forward.Results1.A total of 350 patients with acute ischemic stroke were investigated,18.8% of patients received effective treatment within 1 hour after arriving at the emergency and81.2% of patients had in-hospital delay.Binary Logistic Regression showed that those who did not start the Green Channel [OR=7.417(95% CI: 3.849,14.193),P<0.001],and the low level of knowledge about stroke [OR=5.224(95% CI: 2.529,10.792),P<0.001]would increase the occurrence of in-hospital delay,and night shift visits [OR=0.351(95%CI: 0.179,0.686),P=0.002] would decrease the occurrence of in-hospital delay.2.In the comparison between the emergency treatment process of patients and the standard time stipulated by the National Institute of Neurological Disease and Stroke(NINDS),the difference between the treatment time of 96.00(71.75,123.00)minutes and the standard time of 60 minutes in the “emergency treatment-start treatment” is the largest;The difference between 57.5(53.00,60.00)minutes in the time group and 108.00(84.25,128.00)minutes in the delay group was the largest.In the comparison of the queuing time of the patient’ s emergency treatment process,in the “brain CT scan”process,the queuing time of 18 minutes in the delayed group was significantly longer than that in the 9 min in the timely group.3.The results of linear regression showed that in the process of “ECG examination”and “effective treatment”,there was a dependency between nurse grade and patient queuing time(P<0.05)and showing a reverse linear change trend.4.The simulation results showed that the higher the priority of patients queuing up,the less time it took to see a doctor in the emergency treatment of stroke patients.In addition,there is still room for deployment of the number of nurses in emergency treatment posts,which can be increased by 1～2 by a small margin.Conclusion1.The in-hospital delay of acute ischemic stroke patients was severe and needs further optimization and improvement.2.Those who did not start the green channel,day shift doctors and stroke patients with low knowledge of stroke were more likely to have in-hospital delays.Patients have been in the emergency treatment process for a long time,and the “CT scan” is the key link that causes the delay of patients.3.The grade and number of emergency nurses affected the queuing time of stroke patients and resulted in-hospital delays. |
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