课题研究型品管圈在构建基于ERAS理念下膝关节置换围手术期管理模式中的应用  

Application of task achieving quality control circle in ERAS concept to the construction of the total knee arthroplasty perioperative management mode

作　　者：贾静[1] 徐冠群 孟楠 王婷[2] 王倩[1] 侯丽 方玉凤 蒋玲玲 王国栋[3] JIA Jing;XU Guanqun;MENG Nan;WANG Ting;WANG Qian;HOU Li;FANG Yufeng;JIANG Lingling;WANG Guodong(Department of Quality and Safety Management,2Out-Patient Department,3Joint and Sports Medicine Section,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院质量与安全管理部 [2]济宁医学院附属医院门诊部 [3]济宁医学院附属医院关节与运动医学科,济宁272029

出　　处：《济宁医学院学报》2023年第4期243-248,共6页Journal of Jining Medical University

基　　金：济宁市重点研发计划(软科学项目)(2022JNZC065)。

摘　　要：目的探讨课题研究型品管圈在构建基于加速康复外科(enhanced recovery after surgery,ERAS)理念下膝关节置换围手术期管理模式中的应用。方法成立“膝望圈”及圈外专家咨询团,依据课题研究型品管圈操作步骤,从人员、制度、方法、信息、设备5个层面分析现状,明确6大攻坚点,多方拟定对策并加以筛选判断,从组建多学科“环抱式”围手术期安全管理模式、建立五位一体“动无忧”康复安全策略、建立“智信行”膝关节置换临床路径信息化管理网络等方面改进。结果构建了基于ERAS理念下膝关节置换围手术期管理模式,优化了膝关节置换术临床路径。与改善前相比,康复风险评估落实率(41%提升至100%)及术后屈曲功能相关指标显著提升,患者术后首次下床时间[(16.5±0.41)h降至(9.6±1.11)h]、膝关节屈曲达标时间[(147.4±17.6)h降至(86.9±10.1)h]、改善后临床路径完成时间、均次康复费用以及均次住院费用均显著下降。结论课题研究型品管圈活动可有效推进基于ERAS理念下膝关节置换围手术期管理模式的构建,对规范临床诊疗行为,提高医疗质量,有积极促进作用,值得在医疗服务的现代化发展中推广应用。Objective To explore the application of the task achieving quality control circle in ERAS concept to the construction of the total knee arthroplasty perioperative management mode.Methods To establish the quality control circle and the experts advisory out of the circle,and to analyze current situation of personnel,systems,methods,information,equipment;to define and make effort to solve the 6 difficult points in multiple aspects according to the operational procedure;to make improvements by developing a multi-disciplinary team perioperative management system、FIVE-IN-ONE“Worry-free”rehabilitation safety strategy、“Wisdom、belief and practice”clinical pathway information management network for total knee arthroplasty.Results The model of the total knee arthroplasty perioperative management in ERAS concept was constructed,optimizing the clinical pathway of total knee arthroplasty,which increased the rate of rehabilitation risk assessment(from 41%to 100%)and the related indexes of postoperative flexion function,the time of first off-bed(from 16.5±0.41 h to 9.6±1.11 h),the time of knee flexion(from 147.4±17.6 h to 86.9±10.1 h),improved clinical pathway completion time,average rehabilititation cost and the average cost of hospitalization decreased significantly.Conclusion Using the method of the task achieving quality control circle can effectively promote the construction of the total knee arthroplasty perioperative management mode,and play a positive role in standardizing clinical diagnosis and treatment behavior and improving medical quality of medical institutions.It is worthy of popularizing and applying in the modern development of medical service.

关 键 词：课题研究型品管圈 ERAS理念 膝关节置换术 围手术期 

分 类 号：R47[医药卫生—护理学]