某院重症监护患者非医嘱离院影响因素分析  

Analysis on the Influencing Factors of Non-medical Leave for Critically Ill Intensive Care Patients in a Certain Hospital

作　　者：梁盼 曾繁端[1] 刘涛[1] Liang Pan;Zeng Fanduan;Liu Tao(The First Affliated Hospital of Guangdong Pharmaceutical University,Guangzhou 510080,Guangdong Province,China;不详)

机构地区：[1]广东药科大学附属第一医院,广东省广州市510080

出　　处：《中国病案》2025年第2期67-70,共4页Chinese Medical Record

基　　金：广东省普通高校创新团队项目(2022WCXTD011)。

摘　　要：目的 分析某院重症监护患者非医嘱离院的影响因素,为降低非医嘱离院发生率,提高医疗质量,优化医院管理水平提供依据。方法 通过病案管理信息系统获取某院2023年1月1日-12月31日重症监护病房非医嘱离院和医嘱离院患者住院病案首页信息,运用SPSS25.0软件对数据进行统计分析,采用χ^(2)检验对各自变量与因变量的关系进行探索,二分类Logistic回归分析对非医嘱离院的影响因素进行筛选。结果 该院重症监护病房非医嘱离院率为25.89%,非医嘱离院患者中男女比例2.1:1,Logistic回归结果显示住院科室(OR=9.330)、是否首次住院(OR=2.752)与住院总费用(OR=0.091)是重症监护患者非医嘱离院的主要影响因素(R2=0.613)。综合ICU(66.38%)和首次住院(60.34%)患者非医嘱离院率更高,住院总费用与非医嘱离院率之间呈同向增长。结论 住院科室、住院次数与住院费用等多种因素影响重症监护患者离院方式选择,医院应对重点科室和病人实行精准监管,提升患者依从性、提高重症救治能力、畅通双向转诊、保障医保结算,从而降低非医嘱离院率。Objectives To analyze the influencing factors of non-medical leave for critically ill intensive care patients in a certain hospital,provide a basis for reducing the incidence of non-medical leave,improve medical quality,and optimize hospital management level.Methods By using the medical record management information system,the medical record front page information of patients who were discharged from the intensive care unit without medical orders and those who were discharged with medical orders from January 1st to December 31st,2023 was obtained.SPSS 25.0 software was used for statistical analysis of the data,and x^(2) test was used to explore the relationship between each variable and the dependent variable.Binary logistic regression analysis was used to screen the influencing factors of non medical order discharge.Results The non-medical leave rate in the intensive care unit was 25.89%,and the male-to-female ratio was 2.1:1,and the logistic regression results showed that the inpatient department(OR=9.330),whether or not to be hospitalized for the first time(OR=2.752)and the total hospitalization cost(OR=0.091)were the main influencing factors for the non-medical leave of intensive care patients(R2=0.613).The non-medical leave rate of patients in the comprehensive ICU(66.38%)and first-time hospitalization(60.34%)was higher,and the total hospitalization cost and the non-medical leave rate increased in the same direction.Conclusions Hospitals should implement precise supervision of key departments and patients,improve patient compliance,improve the ability to treat critical ill cases,smooth two-way referral,and ensure medical insurance settlement,so as to reduce the discharge rate of non-medical leave.

关 键 词：重症监护患者 非医嘱离院 影响因素 LOGISTIC回归分析 

分 类 号：R197.323[医药卫生—卫生事业管理]