基于医嘱系统的临床路径变异的原因分析及对策  

Analysis on the causes of variation of clinical pathway system with medical order as the core and Countermeasures

作　　者：尹璇[1] Yin Xuan(The third people’s Hospital of Huizhou,Huizhou,Guangdong,516000,China)

机构地区：[1]惠州市第三人民医院质控科,广东惠州516000

出　　处：《江苏卫生事业管理》2020年第3期306-309,共4页Jiangsu Health System Management

基　　金：2019年度惠州市医疗卫生类科技计划项目资助(2019Y184)。

摘　　要：目的:通过对某院临床路径信息系统产生的变异情况进行分析,查找临床路径信息化管理工作中存在的问题,并制定对策。方法:对某院2018年1月-2019年10月间完成路径病例的31604项变异明细进行分析,比较变异类型、变异原因的分布情况。结果:2018年1月-2019年10月期间,共有39597人次完成路径工作,有19923人次产生变异31604项,系统变异率为50.31%;主要变异类型为“路径外医嘱超标”(49.50%)、“未按阶段要求执行”(31.00%);“临床路径设计与实际工作不符”(46.33%)、“变异识别错误”(18.46%)、“病情变化、出现并发症”(15.23%)。结论:某院临床路径信息化管理主要问题在于临床科室的重视程度不足、系统设计存在遗漏、与个性化诊疗的矛盾。对策上可以从“落实考核,优化指标”、“转变观念,优化文本”、“收集意见,优化系统”三方面着手,降低变异的发生,从而提高临床路径的执行质量。Objective:By analyzing the variation of clinical pathway system in a certain hospital,the problems in clinical pathway management were found and countermeasures were made.Method:Statistics and analysis of 31,604 cases completed from the clinical pathway system in a certain hospital from January 2018 to October 2019,compare variation types and distribution of cause of variation.Result:The data showed that there were 39,597 cases completed the path work,31,604 specific variants in 19,923 cases,system variability is 50.31%,among which the doctor's order exceeded out of path(49.5%),not implemented as required(31.00%)clinical path way design is inconsistent with the actual work(46.33%),variation recognition error(18.46%),disease change and complications(15.23%).Conclusion:The main problems of clinical path information management in a certain hospital lies in the lack of attention of clinical departments,the flaw of system design,and the contradiction with personalized diagnosis and treatment.The countermeasures can be taken from three aspects:implementation of assessment and optimization of indicators,change of concept and optimization of text,collection of opinions and optimization of system,so as to reduce the occurrence of variation and improve the implementation quali ty of clinical pathway.

关 键 词：临床路径 变异 分析 对策 

分 类 号：R197.39[医药卫生—卫生事业管理]