PDCA循环法在提高日间手术占比中的应用研究  

Application Research of PDCA Cycle Method in Increasing the Proportion of Ambulatory Surgery

作　　者：孟楠 李红敏 王倩[1] 董良 贾静[1] 赵晓伟[1] MENG Nan;LI Hongmin;WANG Qian;DONG Liang;JIA Jing;ZHAO Xiaowei(Department of Hospital Quality and Safety Management,Affiliated Hospital of Jining Medical University,Jining Shandong 272029,China;School of Public Health,Jining Medical University,Jining Shandong 272029,China;Hospital Office,Jining Public Health Medical Center,Jining Shandong 272029,China)

机构地区：[1]济宁医学院附属医院医院质量与安全管理部,山东济宁272029 [2]济宁医学院公共卫生学院,山东济宁272029 [3]济宁市公共卫生医疗中心医院办公室,山东济宁272029

出　　处：《中国卫生标准管理》2024年第20期40-44,共5页China Health Standard Management

基　　金：国家卫生健康委医院管理研究所医疗质量(循证)管理研究项目(YLZLXZ23G094);济宁医学院附属医院“知行”课题(ZX-MS-2022-003)。

摘　　要：目的探讨计划-实施-检查-处理(plan-do-check-act,PDCA)循环法在提高日间手术占比中的应用效果。方法于2019年1—11月开展PDCA活动,通过基线调研2019年1—3月济宁医学院附属医院开展日间手术例数,统计日间手术占比。针对日间手术占比低通过原因分析,设定活动目标并拟定对策,于2019年4—8月实施拟定对策并确认效果,2019年9—11月将有效对策标准化并持续实施。对2019年1—3月(改善前)与2019年9—11月(改善后)的日间手术占比情况进行比较。结果开展PDCA活动后日间手术占比由改善前的8.50%提高至改善后的21.50%,差异有统计学意义(P<0.001)。日间手术患者住院时间短于非日间手术,均次费用、均次药费、均次抗菌药物药费、药占比、抗菌药物费用占比均低于非日间手术(P<0.001)。以腹腔镜胆囊切除术为观察对象,日间手术患者住院时间短于非日间手术,均次费用、均次药费、均次抗菌药物药费、药占比、抗菌药物费用占比均低于非日间手术(P<0.001)。结论PDCA循环法可显著提高日间手术占比;同时日间手术的模式缩短了住院时间,提高了患者满意度,降低了经济成本,社会效益显著。Objective To explore the application effect of plan-do-check-act(PDCA)circulation method in improving the proportion of ambulatory surgery.Methods PDCA activities were carried out from January to November 2019.Based on the baseline survey,the number of ambulatory surgery carried out in Affiliated Hospital of Jining Medical University from January to March 2019 was counted.In view of the low proportion of ambulatory surgery,through the analysis of the reasons,the activity objectives were set and the countermeasures were formulated.The countermeasures were implemented from April to August in 2019 and the effects were confirmed.The effective countermeasures were standardized and continuously implemented from September to November in 2019.The proportion of ambulatory surgery from January to March in 2019(before improvement)was compared with that from September to November in 2019(after improvement).Results After PDCA activity,the proportion of ambulatory surgery increased from 8.50%to 21.50%after improvement,and the difference was statistically significant(P<0.001).The duration of hospital stay in day surgery patients was shorter than that in non-day surgery patients,and the average cost,average drug cost,average antibiotic drug cost,drug proportion and antibiotic cost ratio were lower than those in non-day surgery patients(P<0.001).Taking laparoscopic cholecystectomy as the object of observation,the hospital stay of day surgery patients was shorter than that of non-day surgery,and the average cost,average drug cost,average antibiotic drug cost,drug proportion and antibiotic cost ratio were lower than those of non-day surgery(P<0.001).Conclusion PDCA cycle method can significantly increase the proportion of ambulatory surgery,while the ambulatory surgery mode can shorten the length of hospital stay,improve patient satisfaction,reduce economic costs,and has significant social benefits.

关 键 词：PDCA 日间手术 日间手术占比 住院时间 患者满意度 经济成本 

分 类 号：R197[医药卫生—卫生事业管理]