摘要
目的观察将戴明环(PDCA)循环管理法应用于病案管理过程的具体效果,以为临床提供依据。方法选取2022年1—6月山东省公共卫生临床中心病案室收纳的210份病案、6名工作人员作为对照组,选取2022年7—12月病案室收纳的210份病案、6名工作人员作为观察组。对照组实施常规管理模式,观察组实施PDCA循环管理模式。比较两组工作人员管理效率、病案质量、缺陷率情况。结果观察组病案调阅平均时间、病案复印平均时间均少于对照组,差异有统计学意义(P<0.05)。观察组检查单、医嘱单、诊断单、出院单等病案质量评分均高于对照组,差异有统计学意义(P<0.05)。观察组检查单欠缺、鉴别诊断缺漏、特殊检查未记录、知情同意书欠缺、用药事项存在缺漏、疗效评价不足、ICD编码错误、未及时回收等病案质量缺陷率均低于对照组,差异有统计学意义(P<0.05)。结论在病案管理过程实施PDCA循环管理模式效果切实,该管理模式能够提高病案管理效率,降低病案质量缺陷率。
Objective To observe the specific effect of applying the Deming Circle(PDCA)cycle management method to the case management process,in order to provide a basis for clinical practice.Methods From January to June 2022,210 medical records and 6 staff members in the medical record room of Shandong Public Health Clinical Center were selected as the control group,and 210 medical records and 6 staff members in the medical record room from July to December 2022 were selected as the observation group.The control group implemented the routine management mode,and the observation group implemented the PDCA cycle management mode.The management efficiency,medical record quality and defect rate of the two groups were compared.Results The average time of medical record review and the average time of medical record copying in the observation group were less than those in the control group,and the differences were statistically significant(P<0.05).The quality scores of medical records such as examination form,medical order form,diagnosis form and discharge form in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).The quality defect rates of medical records such as lack of checklist,omission of differential diagnosis,failure to record special examination,lack of informed consent,omission of medication items,insufficient evaluation of curative effect,ICD coding error and failure to recycle in time in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion The implementation of PDCA cycle management model in the process of case management is effective,and this management model can improve the efficiency of case management and reduce the rate of case quality defects.
作者
乔秀丽
张晓平
王丽慧
QIAO Xiuli;ZHANG Xiaoping;WANG Lihui(Shandong Public Health Clinical Center,Jinan,Shandong Province,250000 China)
出处
《中国卫生产业》
2023年第19期17-20,共4页
China Health Industry
关键词
病案管理
PDCA循环管理法
病案质量
Case management
PDCA cycle management method
Medical record quality
