摘要
目的探讨医院科际间普通会诊特征,提出管理建议。方法以北京市某大型综合三级甲等医院为研究对象,通过住院电子病历系统提取2017年7月1日至2018年6月30日全院实际发生的院内科际普通会诊数据,包含会诊申请科室、提交时间、会诊应邀科室、会诊完成时间等信息;同时,调取各临床科室同时期内的出院人次、病例组合指数(CMI)、术前平均住院日等数据。采用Pearson和Spearman法进行相关性分析,采用独立样本秩和检验进行均值比较。结果全院科际间普通会诊人次与出院患者人次比为0.44,心血管内科、眼科和神经内科应邀会诊量较高,神经内科、内分泌科和风湿免疫科发出会诊申请比例较高;外科系统科室会诊申请比与CMI相关性较强,r=0.63(P<0.05);全院24 h内会诊完成率为90.08%,其中64.79%的超时会诊由35.63%的会诊医师导致。结论应强化基础保障和信息化建设,以应对巨大的科际会诊需求并保障患者安全;加强会诊指征把控,并将整合医学模式应用于医师培养,提升临床综合诊疗能力以减少不必要会诊;优化流程,将住院会诊前移至门诊,缩短术前平均住院日;通过绩效考核机制提高会诊积极性并保障会诊质量。
Objective To explore characteristics of general inter-departmental consultations in a hospital and put forward management strategy suggestions.Methods A large tertiary general hospital in Beijing was cited as the research object.Data were extracted from the EMR of the in-hospital inter-departmental consultations from July 1,2017 to June 30,2018,including information such as applying departments,submission time,invited departments,consultation completion time among others.Also collected were data such as discharges,case combination index(CMI),and preoperative average hospitalization days of clinical departments.Pearson and Spearman methods were used to perform correlation analysis,and independent sample Wilcoxon rank sum test was performed for the mean comparison.Results The ratio of consultations to discharged patients was 0.44,while consultation workload of cardiovascular medicine,ophthalmology and neurology was higher,and consultation applications issued by neurology,rheumatology and endocrinology departments were higher.For surgical departments,the correlation between demand of consultations and CMI was strong,r=0.63(P<0.05).The completion rate of consultation within 24 hours was 90.08%,and 64.79%of overtime consultations were caused by 35.63%of the consultation physicians.Conclusions It is imperative to enhance infrastructure support and information system construction to meet huge demands of inter-departmental consultations and to ensure patient safety;To further examinations of consultation purposes and improve doctors′integrative abilities of diagnosis and treatment by introducing HIM mode to the training system,for the purpose of reducing unnecessary consultations;Optimize the process,shorten preoperative average length of stay by bringing forward inpatient-consultations to outpatient department;Inspire consultation enthusiasm and ensure consultation quality through performance appraisal mechanism.
作者
董书
于涛
夏志伟
胥雪冬
付卫
Dong Shu;Yu Tao;Xia Zhiwei;Xu Xuedong;Fu Wei(Department of Medical Affairs,Peking University Third Hospital,Beijing 100191,China;Department of Medical Record,Peking University Third Hospital,Beijing 100191,China;President Office,Peking University Third Hospital,Beijing 100191,China)
出处
《中华医院管理杂志》
CSCD
北大核心
2019年第11期919-924,共6页
Chinese Journal of Hospital Administration
关键词
病例管理
会诊
病例组合指数
整合医学
效率
Case management
Consultation
Case mix index
Holistic integrative medicine
Efficiency
作者简介
通信作者:胥雪冬,Email:xuxd59692158@126.com。
