基于RCA方法的某三级甲等医院非计划再手术分析  

Root Cause Analysis of Unplanned Reoperations of a Tertiary Hospital

作　　者：宋涵超 张艳丽 于涛[1] 董书[1] 胥雪冬[1] Song Hanchao;Zhang Yanli;Yu Tao(Peking University Third Hospital,Beijing,100191,China;不详)

机构地区：[1]北京大学第三医院,北京100191 [2]国家卫生健康委医院管理研究所,北京100044

出　　处：《中国医院管理》2023年第1期49-52,共4页Chinese Hospital Management

摘　　要：目的 调查北京市某三级甲等医院非计划再手术现状与存在的问题,分析发生的原因,并提出对策建议。方法 查询医院2019年发生的非计划再手术患者的临床资料,使用根本原因分析方法分析发生非计划再手术的近端原因与根本原因,并提供相应的对策建议。结果 医院共发生非计划再手术388例,非计划再手术率为0.51%,非计划再手术率最高的科室为心脏外科。导致非计划再手术的近端原因包括未达到手术效果、出血、感染、植入物相关并发症、其他以及神经组织损伤或水肿,根本原因包括患者、临床医生和管理制度3方面。结论 非计划再手术可发现医疗过程中的异常情况,并用以评价医疗质量;非计划再手术的近端原因具有特异性,为科室提升医疗质量提供数据支持;完善非计划再手术管理制度建设,形成闭环管理;完善手术分级管理制度,落实手术医师资质与授权管理;提升信息化建设水平,助力医疗安全。Objective To investigate the status and present problems of unplanned reoperations in teritary grade A hospital in Beijing,discuss the causes of unplanned reoperations,and provide suggestions for improvement. Methods RCA was adopted to analyze proximal causes and root causes of the data of unplanned reoperations in 2019. Results There were 388 unplanned reoperations,and the re-operative rate was 0.51%. The department with the highest re-operative rate was cardiology department. Proximal causes of unplanned reoperation were failure to treatment,bleeding,infection,implants-complication,other and angioedema. Root causes were patients,surgeons and management systems. Conclusion The unplanned reoperation can be used for reflecting problems of medical process and assessing the medical quality. The proximal causes of unplanned reoperations is specificity, which can identify opportunities for quality improvement. Hospitals need to advance the management of operation and surgery grading,and promote the informatization construction contribute to improve medical quality.

关 键 词：非计划再手术 根本原因分析 医疗质量 

分 类 号：R197.323.2[医药卫生—卫生事业管理]