PDCA在提升住院病案归档率中的运用  

Application of PDCA in Improving the Filing Rate of Inpatient Medical Records

作　　者：田馨 张立敏 海丽古力·艾买伊力 古丽米拉·肯杰别克 卢武红[2] Tian Xin;Zhang Limin;Hailiguli·Aimaiyili;Gulimila·Kenjiebieke;Lu Wuhong(School of Public Health,Xinjiang Medical University,Urumqi 830017,Xinjiang Uygur Autonomous Region,China;不详)

机构地区：[1]新疆医科大学公共卫生学院,新疆维吾尔自治区乌鲁木齐市830017 [2]新疆医科大学第一附属医院,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国病案》2023年第7期8-10,共3页Chinese Medical Record

摘　　要：目的利用PDCA管理工具提升住院病案2日归档率,促进医院质量管理持续改进。方法为提升病案归档率,某院于2022年1月1日起实施PDCA质量改进措施,通过头脑风暴评价法分析病案迟归的原因和病案归档率低的影响因素。调取2021年9月1日-12月31日期间61168份住院病案为对照组,2022年1月1日-5月31日期间80834份住院病案作为观察组,分析对比PDCA改进前后2日、3日归档率情况。结果改进措施实施前2日归档率为81.72%,实施后归档率提高至91.03%,通过皮尔逊卡方检验得出χ^(2)=2671.326,P<0.001,差异有统计学意义。改进后2日归档率定基增长速度上升至12.69%,3日归档率情况均在99%以上。2日归档率达100%的科室由10个科室增加至73个科室,3日归档率达100%的科室占全院总科室数的87%。结论PDCA质量管理工具实施效果显著,能够有效提高住院病案归档率。Objectives This study aims to use the PDCA management tool to improve the 2-day filing rate of inpatient medical records and promote the continuous improvement of hospital quality management.Methods In order to improve the filing rate of medical records,a hospital implemented PDCA quality improvement measures from January 1,2022,and analyzed the reasons for the late return of medical records and the influencing factors of the low filing rate of medical records through the brainstorming evaluation method.A total of 61,168 inpatient medical records from September 1,2021 to December 31,2021 were used as the control group,and 80,834inpatient medical records from January 1,2022 to May 31,2022 were selected as the observation group.The filing rate at two days and three days before and after PDCA improvement were analyzed and compared.Results The archiving rate was 81.72%two days before the implementation of the improvement measures,and the archiving rate increased to 91.03%after the implementation.Through the Pearson chi-square test,χ^(2)=2671.326,P<0.001,and the difference was statistically significant.After the improvement,the fixed-base growth rate of the 2-day filing rate rose to 12.69%,and the 3-day filing rate was above 99%.The number of departments with a filing rate of 100%on the second day increased from 10 to 73 departments,and the number of departments with a filing rate of 100%on the third day accounted for 87%of the total number of departments in the hospital.Conclusions The implementation effect of PDCA quality management tool is remarkable,which can effectively improve the filing rate of inpatient medical records.

关 键 词：住院病案 归档率 PDCA 持续质量改进 

分 类 号：R197.323[医药卫生—卫生事业管理]