基于临床路径的质量控制管理在骨科日间手术中的应用  

Application of quality control management based on clinical pathway in orthopaedic day surgery

作　　者：聂博渊 王庆玲[1] 李蓓蕾 杨朝晖[1] NIE Boyuan;WANG Qingling;LI Beilei;YANG Zhaohui(Day Surgery Department,the Second Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,P.R.China)

机构地区：[1]山西医科大学第二医院日间手术部,太原030001

出　　处：《华西医学》2021年第2期173-177,共5页West China Medical Journal

摘　　要：目的探讨临床路径在骨科日间手术患者中的应用。方法回顾性选取山西医科大学第二医院日间手术部2020年5月-10月预约骨科日间手术的采用临床路径管理的患者(路径组)以及2019年5月-10月预约骨科日间手术的采用常规临床管理的患者(常规组)。比较两组患者的一般情况、医师工作效率、医疗成本和医疗质量。结果最终路径组纳入246例患者,常规组纳入391例患者。两组患者在性别、年龄及病种分布方面差异无统计学意义(P>0.05)。与常规组相比,路径组在医师次均开具医嘱耗时[(5.64±3.29)vs.(2.12±1.05)min]、次均医嘱修改次数[(1.40±0.24)vs.(0.38±0.19)次]、病案3日归档率(90.28%vs.97.97%)、住院费用[(7462.10±1035.01)vs.(6252.52±1189.05)元]、药品费用[(652.21±88.53)vs.(437.17±108.20)元]、住院时间[(1.23±1.04)vs.(1.02±0.18)d]以及延迟出院率(7.93%vs.2.03%)方面均有优势,差异有统计学意义(P<0.05)。两组的非计划再手术率、非计划再住院率及患者满意度差异无统计学意义(P>0.05)。结论在实施骨科日间手术的过程中,相比常规临床管理,临床路径管理能够更加有效地提高工作效率、降低医疗成本、提升医疗质量,具有十分积极的效果,值得推广应用。Objective To explore the application of clinical pathway in patients undergoing orthopedic day surgery.Methods Patients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2020 were selected as the clinical pathway group,and all of them were managed by clinical pathway.Patients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2019 were selected as the routine group,and all of them were managed by conventional clinical methods.The general conditions of patients,physicians’work efficiency,medical costs and medical quality were compared between the two groups.Results The clinical pathway group included 246 patients,and the routine group included 391 patients.There was no significant difference in gender,age or disease distribution between the two groups(P>0.05).Compared with the routine group,the clinical pathway group had obvious advantages in terms of average time spent by a physician in issuing a medical order each time[(5.64±3.29)vs.(2.12±1.05)min],average number of revisions per physician’s order(1.40±0.24 vs.0.38±0.19),rate of filing medical records within 3 days(90.28%vs.97.97%),hospital costs[(7462.10±1035.01)vs.(6252.52±1189.05)yuan],drug costs[(652.21±88.53)vs.(437.17±108.20)yuan],length of stay[(1.23±1.04)vs.(1.02±0.18)d]and delayed discharge rate(7.93%vs.2.03%),with statistically significant differences(P<0.05).There was no significant difference between the two groups in terms of unplanned reoperation rate,unplanned rehospitalization rate,or patient satisfaction(P>0.05).Conclusion Compared with routine clinical management,clinical pathway management can improve work efficiency,reduce medical cost and improve medical quality more effectively in the implementation of orthopedic day surgery,which has very positive effects and is worthy of promotion and application.

关 键 词：临床路径 质量控制管理 骨科日间手术 

分 类 号：R197.323[医药卫生—卫生事业管理]