质量管理工具在非预期重返手术管理中的应用  

Application of Quality Tools in Unexpected Returns to Operation

作　　者：杨颖[1] 周忠彬 乔媛媛 高子涵 张伟[2] YANG Ying;ZHOU Zhongbin;QIAO Yuanyuan;GAO Zihan;ZHANG Wei(Quality Control Sector,Sixth Medical Center of PLA General Hospital,Beijing 100048;Department of Military Medical Service,Sixth Medical Center of PLA General Hospital,Beijing 100048)

机构地区：[1]解放军总医院第六医学中心质量管理科,北京100048 [2]解放军总医院第六医学中心卫勤部,北京100048

出　　处：《解放军医院管理杂志》2021年第9期848-849,共2页Hospital Administration Journal of Chinese People's Liberation Army

摘　　要：目的对三甲医院非预期重返手术进行管理和效果评价。方法对2020年1—6月非预期重返手术例数和科室进行分析,依据帕累托法则,对重返率高的重点科室采用鱼骨图进行原因分析,并根据"瑞士奶酪模型"进行为期6个月的PDCA系统性整改。结果 2020年1—6月全院非预期重返手术率为0.39%,重点科室为1.79%,非预期重返手术患者总死亡率为42.86%,整改后2020年7—12月全院非预期重返手术率为0.20%,重点科室为0.34%,无一例非预期重返手术患者死亡。差异有统计学意义。讨论运用多种质量管理工具进行非预期重返手术等医疗质量安全指标的改进可取得满意效果;需采取系统化的有效措施巩固成效,持续提高医疗质量安全。Objective To manage and evaluate the effects of unexpected returns to operation in a comprehensive hospital. Methods The number and departments of unexpected returns to operation from January to June 2020 were analyzed. And based on the Pareto principle, fishbone diagram for root cause analysis was adopted for key departments and the "Swiss cheese model" for a six-month PDCA systemic rectification was applied. Results The rate of unexpected returns to operation was 0.39% in the whole hospital while the rate was 1.79% in key departments. And the total mortality rate with unexpected returns was 42.86%. After the rectification, the rate of unexpected returns to operation was 0.20% in the whole hospital from July to December, 2020, while the rate was 0.34% in key departments. And no patient died of unexpected returns. The difference was statistically significant. Discussion A variety of quality management tools to improve medical quality and safety indicators such as unexpected returns to operation have been adopted successfully with satisfactory results, and systematic and effective measures should be taken to consolidate the results, so as to continuously improve the quality and safety of medical treatment.

关 键 词：非预期重返手术 质量管理工具 效果评价 

分 类 号：R197.32[医药卫生—卫生事业管理]