重症医学科质量控制核查表的设计及应用研究  

Design and application of Checklist for quality control in intensive care unit

作　　者：赵士兵[1] 邹琪[1] 张超[2] 张伦军[3] 吴强[1] 邓晰明[1] 汪华学[1] Zhao Shibing;Zou Qi;Zhang Chao;Zhang Lunjun;Wu Qiang;Deng Ximing;Wang Huaxue(Department of Intensive Care Unit,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui,China;Department of Medical Records Room,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui,China;Department of Laboratory Medicine,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui,China)

机构地区：[1]蚌埠医学院第一附属医院重症医学科,安徽蚌埠233004 [2]蚌埠医学院第一附属医院病案科,安徽蚌埠233004 [3]蚌埠医学院第一附属医院检验科,安徽蚌埠233004

出　　处：《中华危重病急救医学》2021年第4期466-471,共6页Chinese Critical Care Medicine

基　　金：安徽省临床重点专科建设项目(2017-27)。

摘　　要：目的设计重症医学科质量控制(质控)核查表(Checklist)并观察其临床应用效果。方法通过查阅《重症医学专业医疗质量控制指标(2015年版)》等指南及相关文献,设计重症医学科质控Checklist,包括质控数据收集、病历质量核查、特殊诊疗、院感防控督查4个部分。每月由副高以上职称医师担任质控主任,负责全科质控的实施,每日晨交班时完成过去24 h内的数据收集,对当日拟进行的特殊诊疗行为进行讨论、登记,并与护理组长协调,在全天对全科室进行质量把控,监督每位医务人员的不合理行为,对运行病历和出科病历进行检查,巡查各岗人员值班状况。采用回顾性研究方法,分析2018年和2019年(实施Checklist)与2017年(未实施Checklist)的数据,包括收治患者情况、科室管理资料、重症医学科住院时间以及三管感染发生率〔呼吸机相关性肺炎(VAP)、导管相关性血流感染(CRBSI)、导尿管相关性尿路感染(CAUTI)〕、标化病死率等主要质控指标。结果2017、2018、2019年收治患者数分别为373、446、480例,2018年和2019年的年增长率分别为19.57%、7.62%,2019年较2017年增长了28.69%。3个年度收治患者年龄和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)差异均无统计学意义。与2017年比较,2018年和2019年患者重症医学科住院时间均明显缩短(d:8.99±6.12、9.14±7.02比10.20±7.21),VAP、CRBSI和CAUTI发生率均明显降低〔VAP(例/千机械通气日):12.97±3.60、9.62±3.14比17.48±4.89,CRBSI(例/千导管日):3.75±2.19、3.87±1.87比6.19±3.13,CAUTI(例/千导尿管日):3.29±2.18、3.28±1.87比5.61±3.18〕,标化病死率亦明显降低〔(77.27±7.24)%、(70.61±7.49)%比(84.41±9.05)%〕,每月院感防控督查发现的不合理人次明显减少(人次:54.00±6.30、41.08±10.76比72.08±19.68),每月特殊诊疗人次大幅增加(人次:1056.67±235.27、1361.75±278.48比722.25±145.96),抗菌药物治疗前病原学送检�Objective To design a Checklist for quality control in intensive care unit and observe the effect of clinical application.Methods By consulting guidelines and literature,such as Critical care medicine professional medical quality control index(2015 edition),the quality control Checklist of intensive care unit was designed.It included four parts:quality control data collection,medical record quality verification,special diagnosis and treatment,and hospital infection prevention and control supervision.Every month,a doctor with a senior professional title served as the quality control director,and was responsible for the quality control of the department's medical care,including collecting data of the past 24 hours during the morning handover,discussing and registering special diagnosis and treatment behaviors that would be performed on the day,and coordinating with the nursing team leader,controlling the quality of the whole department throughout the day,such as supervising each medical staff if they had unreasonable behaviors,checking the running and discharge medical records,and inspecting the status of the staff on duty.The data in 2018,2019(Checklist implemented)and 2017(Checklist not implemented)were retrospectively analyzed,including the status of admitted patients,department management information,length of intensive care unit(ICU)stay,and the incidence of three-tube infection[ventilator-associated pneumonia(VAP),catheter-related bloodstream infection(CRBSI),catheter-associated urinary tract infection(CAUTI)],and standardized mortality,etc.Results From 2017 to 2019,the number of patients admitted was 373,446,and 480,with annual growth of 19.57%and 7.62%in 2018 and 2019,respectively,and an increase of 28.69%in 2019 compared with 2017.There was no statistically significant difference in the average age and acute physiology and chronic health evaluationⅡ(APACHEⅡ)of patients in the three years.Compared with 2017,the length of ICU stay of patients in 2018 and 2019 were significantly shortened(days:8.99±6.12,

关 键 词：重症医学 质量控制 核查表 

分 类 号：R197.323[医药卫生—卫生事业管理]