临床路径下单病种护理成本的核算研究

目的：以单侧输尿管结石钬激光碎石术为例,探讨单病种护理成本的核算方法,为制订单病种收费标准提供参考。方法根据医院各类统计报表及自行设计的临床护理路径跟踪记录表,按照项目成本核算的6大要素,核算临床路径下单侧输尿管结石钬激光碎石术各护理项目的平均成本,计算病种护理总成本,并根据实际收费情况计算成本回收率。结果临床路径下单侧输尿管结石钬激光碎石术的护理成本为597．23元,其中人力成本269．97元,占总成本的45．20％;平均实际护理收费为145．15元,成本回收率为24．30％。结论开展以单病种临床路径为基础的护理成本核算研究,有助于合理制订护理收费标准,体现护理人员的劳动价值。     

医院成本核算的难点与策略

目的：评价医院管理中成本核算方法，分析成本核算的发展趋势。方法：以国内文献资料为基础，对一些医院目前采用的成本核算方法进行调查了解，着重探讨有关大型医疗设备核算、痫种医疗成本核算及药品成本核算的最佳方法。结果和结论：成本预测、成本控制和成本评价是成本管理的发展趋势，搞好成本核算基础工作，加强医院内部管理是适应医保制度改革的必由之路。     

医院成本控制的重要性探讨和方法

当今社会无论是营利性医院还是非营利性医院，都应实行成本核算，推行成本控制，这是大势所趋。成本控制在医院成本核算中占据着非常重要的地位，本人通过多年来在实际工作中的探索和体会，将医院成本控制的重要性、方法及注意的问题归纳如下：     

病种分类法

正以病种为成本计算对象,归集与分配费用,计算出每一病种所需护理照顾成本的方法。按病种服务收费是将全部的病种按诊断、手术项目、住院时间、并发症和病人的年龄、性别分成若干个病种组,对同一病种组的任何病人,无论实际住院费用是多少,均按统一的标准对医院进行补偿。     

婴幼儿与成人护理单项成本的核算与比较

摘要：目的 比较婴幼儿与成人各个护理项目的成本，为管理部门合理配备人力资源，制定合理的收费标准提供依据。方法 按单项成本核算方法，对内科、儿科每日位于前１０位的７个护理项目的各成本构成及总成本进行核算，并与目前管理部门所制定的收费标准进行比较。结果 婴幼儿各个护理项目的人力成本和总成本是成人的１．１８～２．５０倍和１．１４～２．２３倍。各护理项目的核算成本与管理部门制定的收费标准不相符，除雾化吸入可以收回成本外，其他项目的成本回收率较低。结论 管理部门需依据护理质量管理的要求，在评估科室护理服务人力成本投入的前提下，合理配备护理人力资源，制定合理的专科收费标准，才能真正体现专科护理人员的工作价值。关键词：婴幼儿；　成人；　护理项目；　护理成本；　成本核算中图分类号：Ｒ４７；Ｒ１９７．３２３　　文献标识码：Ａ　　文章编号：１００１-４１５２（２００７）１１-０００５-０３     

临床护理路径在股骨干骨折患者中的护理

目的：探索临床路径在股骨干骨折患者中的实施效果。方法采用前后对照的研究方法，对140例股骨干骨折患者的平均住院日、平均医疗费用及患者出院时的满意度调查进行比较。结果观察实施临床路径后，患者的平均住院日、医疗费用明显下降，而患者对护理工作的满意度明显上升。结论临床路径作为一种科学的工作模式在病种适合的前提下值得在临床护理实践中推广。     

供应室如何配合医院做好成本核算

目的 消毒供应室在成本核算工作上积极配合好医院，提高效益，降低消耗。方法 健全各项规章制度，加强管理，按章办事，充分利用人力物力资源。结果 消毒供应室通过一系列合理有效的策施，调动工作人员自身的积极性和探讨性，很好地配合了医院的成本核算工作。结论 消毒供应室健全的规章制度和成本管理工作能给医院的成本核算工作提供真实、完整、准确的情况。     

临床路径管理定出三年目标

国家卫生计生委办公厅下发通知,要求各省级卫生计生行政部门和医院切实做好临床路径管理工作,到2015年年末,各省（区、市）内所有三级医院、80％的二级医院应当开展临床路径管理,并逐步增加临床路径管理专业和病种数。据介绍,截至2012年年底,我国共制定下发22个专业431个病种的临床路径,其中包括74个县级医院版临床路径。截至今年7月底,全国共有5924家医院开展临床路径管理工作,占二级以上公立医院的77．8％,全国至少有433万例入组临床路径管理的病例。按照要求,到2015年年末,三级综合医院不少于15个专业60个病种开展临床路径管理;三级专科医院不少于10个病种开展临床路径管理;二级综合医院不少于10个专业40个病种实施临床路径管理;二级专科医院不少于8个病种开展临床路径管理。通知要求,各医院要进一步细化各病种临床路径表单,优化诊疗流程,明确治疗药物,限定耗材种类,确定人、出院标准。进一步提高符合临床路径管理病例的入组率和完成率,定期组织对变异原因进行分析、评估,分析变异原因,发现问题并加以改进。逐步建立以医疗服务量、患者满意度、医疗质量、医疗安全、医疗效率和费用控制等为主要内容的综合评估机制,不断完善绩效考核制度,提高临床路径工作质量。——摘自《健康报》     

医院成本核算中的辅助成本分配方法探索

长期以来,医院后勤服务成本、医疗辅助服务成本、医院行政成本未完整、正确分配计入相应的医疗服务项目成本项下,导致现实提供的医疗成本仅是一种不完全成本,这必将相应影响医疗定价、医院决策和医院分配。医院推行成本核算改革是医疗改革及经济发展的必然,医院后勤服务成本、医疗辅助服务成本、医院行政成本分配计入医疗服务项目成本项下已是医院成本核算改革所必须。参阅国内外医院成本核算的模式、方法,并选择性借鉴企业成本核算模式,对医院后勤成本、医疗辅助成本、行政成本的分配方法进行探索,以供医院管理相关人士参阅。     

临床路径在心脏瓣膜置换术后ICU病房管理中的应用及研究

临床路径是医院为了减少医疗成本和有效保证高质量的医疗服务而实施的一种科学的管理方法，我院心脏中心2005年实施了心脏瓣膜置换术的临床路径，已取得了良好效果，现将结果报道如下。     

全成本核算在消毒供应中心的应用

目的:探讨成本核算在消毒供应中心的应用效果。方法:比较我院妇产一科实行成本核算前、后使用无菌器械包的数量并比较2011年两家医院1年的消毒成本。结果:我院妇产一科成本核算前、后无菌器械包使用量有统计学差异(P<0.01)。两家医院消毒成本对比,有统计学差异(P<0.01)。结论:成本核算减少了消耗,降低了医院经营成本,调动了消毒供应中心工作人员的积极性和主动性,保证了工作质量,促进了区域化管理。     

Activity-Based Costing and Its Application in a Turkish University Hospital

Resource management in hospitals is of increasing importance in today's global economy. Traditional accounting systems have become inadequate for managing hospital resources and accurately determining service costs.Conversely, the activity-based costing approach to hospital accounting is an effective cost management model that determines costs and evaluates financial performance across departments. Obtaining costs that are more accurate can enable hospitals to analyze and interpret costing decisions and make more accurate budgeting decisions.Traditional and activity-based costing approaches were compared using a cost analysis of gall bladder surgeries in the general surgery department of one university hospital in Manisa, Turkey. AORN J 89 (March 2009) 573-591. © AORN, Inc, 2009.     

群体性伤害事件原因及特点的分析

目的：通过回顾分析各种群体性伤害事件的原因和特点,探讨综合医院的急诊科应如何制定相应的应急预案。方法：统计我院2004年1月～2006年9月以来的急诊科收治群体性伤害事件的发生原因、人数、年龄、性别、发生时间及采取的应急程序。结果：在所有群体事件发生中按发生案例数从高到低的原因分别为：食物中毒、治安事件、车祸、安全生产事故。按发病人数排列则分别为：食物中毒、车祸事件、治安、安全生产事故。男性多于女性,发病人数集中在21～30岁和31～40岁。我院采取了相应的应急流程,使群体性伤害事件均能够得到妥善安置。结论：食物安全、交通安全、生产安全和治安问题是导致城市中群体伤害事件的主要原因,医院的急诊科应根据群体事故的特点制定相应的应急预案。     

A Cost-Analysis of an Interdisciplinary Pediatric Chronic Pain Clinic

Chronic pain is characterized by high rates of functional impairment, health care utilization, and associated costs. Research supports the use of comprehensive, interdisciplinary treatment approaches. However, many hospitals hesitate to offer this full range of services, especially to Medi-Cal/Medicaid patients whose services are reimbursed at low rates. This cost analysis examines the effect on hospital and insurance costs of patients' enrollment in an interdisciplinary pediatric pain clinic, which includes medication management, psychotherapy, biofeedback, acupuncture, and massage. Retrospective hospital billing data (inpatient/emergency department/outpatient visits, and associated costs/reimbursement) from 191 consecutively enrolled Medi-Cal/Medicaid pediatric patients with chronic pain were used to compare 1-year costs before initiating pain clinic services with costs 1 year after. Pain clinic patients had significantly fewer emergency department visits, fewer inpatient stays, and lower associated billing, compared with the year before without interdisciplinary pain management services. Cost savings to the hospital of $36,228 per patient per year and to insurance of $11,482 per patient per year were found even after pain clinic service billing was included. Analyses of pre-pain clinic costs indicate that these cost reductions were likely because of clinic participation. Findings provide economic support for the use of interdisciplinary care to treat pediatric chronic pain on an outpatient basis from a hospital and insurance perspective.

Utilization of Emergent Magnetic Resonance Imaging in the Diagnosis of Acute Ischemic Stroke

Utilizing an emergent magnetic resonance imaging (MRI) pathway for emergency department patients with acute onset of stroke-like symptoms allows for optimization of acute ischemic stroke treatment. Emergent MRI increases the percentage of patients administered intravenous tissue plasminogen activator (IV tPA) and minimizes stroke-related long-term disabilities. MRI also reduces the overall cost of stroke-related care by (1) preventing unnecessary IV tPA administration and its associated hospital costs and (2) facilitating faster stroke etiology work-up and treatment plan initiation to reduce hospital length of stay. The primary purpose of this article is to summarize two hospitals’ experience utilizing an evidence-based emergent MRI pathway for patients presenting to the emergency department with stroke-like symptoms who may be IV tPA eligible. Secondary purposes are to describe (1) emergent MRI pathway challenges with implemented mitigation strategies and (2) case examples (wake-up stroke; mild stroke-like symptoms with acute ischemic stroke confirmed by MRI).     

Development of a practical costing method for hospitals

To realize an effective cost control, a practical and accurate cost accounting system is indispensable in hospitals. In traditional cost accounting systems, the volume-based costing (VBC) is the most popular cost accounting method. In this method, the indirect costs are allocated to each cost object (services or units of a hospital) using a single indicator named a cost driver (e.g., Labor hours, revenues or the number of patients). However, this method often results in rough and inaccurate results. The activity based costing (ABC) method introduced in the mid 1990s can prove more accurate results. With the ABC method, all events or transactions that cause costs are recognized as "activities", and a specific cost driver is prepared for each activity. Finally, the costs of activities are allocated to cost objects by the corresponding cost driver. However, it is much more complex and costly than other traditional cost accounting methods because the data collection for cost drivers is not always easy. In this study, we developed a simplified ABC (S-ABC) costing method to reduce the workload of ABC costing by reducing the number of cost drivers used in the ABC method. Using the S-ABC method, we estimated the cost of the laboratory tests, and as a result, similarly accurate results were obtained with the ABC method (largest difference was 2.64%). Simultaneously, this new method reduces the seven cost drivers used in the ABC method to four. Moreover, we performed an evaluation using other sample data from physiological laboratory department to certify the effectiveness of this new method. In conclusion, the S-ABC method provides two advantages in comparison to the VBC and ABC methods: (1) it can obtain accurate results, and (2) it is simpler to perform. Once we reduce the number of cost drivers by applying the proposed S-ABC method to the data for the ABC method, we can easily perform the cost accounting using few cost drivers after the second round of costing.     

综合医院应对突发重大传染病疫情的应急护理管理

目的 总结综合医院在应对突发重大传染病疫情时的应急护理管理实践经验,为护理管理者科学应对疫情提供参考。方法 新型冠状病毒肺炎疫情期间,该院护理部在医院疫情防控指挥小组的统一部署下,迅速成立防疫护理组织应急管理小组并启动应急管理预案,配合实施应急管理工作,持续管理护理质量与患者安全,多措并举有力保障疫情防控工作。 结果 在护理部应急管理小组的统一指导下,该院一线2 800余名支援护士顺利协助并完成发热门急诊、隔离病区、方舱医院及其他一线病区患者的重症抢救、检验检查、诊疗转运等救援工作。 结论 该院护理部通过制订护理组织应急管理方案和构建精准化管理策略,为指导各级护理人员进行科学防控疫情和精细化管理提供了保障。     

Activity-Based Resource Allocation: A System for Predicting Nursing Costs

As hospital-based managers are being confronted with changing patterns of reimbursement, ranging from revenue generating to cost management, it is imperative that hospitals know the exact nursing costs associated with the actual care delivered to specific patients. Nursing care has traditionally been bundled into the room rate for patients. This approach is extremely limiting when facilities are negotiating per diem rates and capitated rate contracts. At Braintree Hospital Rehabilitation Network, the nursing department has developed and implemented an activity-based management system to determine the actual cost of nursing care provided to each patient. This approach, which differentiates nursing costs accurately by diagnostic group and by intensity of nursing care, has contributed to the hospital's success in negotiating individual patient contracts with insurers in the managed care environment that increasingly focuses on costs and outcomes. Another result has been to enhance the accuracy of the network's cost accounting system.     

Pain and symptom control for cancer patients at the University Hospital in Essen: integration of specialists' knowledge into routine work

At the University Hospital of Essen, supportive care for patients with cancer and other painful diseases is carried out by an interdisciplinary ambulant pain clinic supported by a pain conference with delegates from all departments involved in the care of cancer patients as permanent members. More than 600 in- and outpatients per year are treated by this institution. This model tends to integrate supportive care into the overall therapeutic concept and routine work and to improve education in this field by bedside teaching and training of local specialists in every department. Therefore, when hospitalization becomes inevitable it is realized within the department mainly concerned with the underlying disease, where the registrar and the physician belonging to the palliative care team work closely together. Scientific research in the field of palliative care, including supportive care, is a further concern of the pain clinic. Evaluation of the model shows that the concept has been realized within a decentralized and interdisciplinary setting; it must, of course, be borne in mind that the staff of the pain control clinic are deeply committed to their work. In conclusion, the way supportive care is realized in Essen can be recommended for large hospitals, and especially for medical schools.     

成都市第三人民医院骨科2008～2010年住院患者疾病及费用构成调查

目的调查成都市第三人民医院骨科2008～2010年度住院患者疾病及费用构成情况,为后续析因分析主要住院疾病负担和有效干预提供更加详尽的基线数据。方法收集该院骨科2008—2010年住院患者病历,按国际疾病分类（ICD-10）标准对出院记录的第一诊断进行分类整理。结果2008—2010年该院骨科住院患者逐年增加,男性以中青年为主,女性以老年为主;3年内前5位系统疾病顺位未变,有6个单病种均保持位于前10位。患者人均费用平均增长8．97％;住院费用构成前三位保持不变,依次为材料费、药品费和治疗费;住院费用支付方式构成前三位依次为自费、社保和公费;支付方式构成中,社保支付呈明显上升趋势,自费支付总体以下降为主。结论①该院2008～2010年骨科住院患者人数呈逐年增高趋势,患者性别与年龄分布趋于稳定。②按ICD-10一级代码分类的疾病谱和单病种较稳定,首位疾病3年来均为腰椎间盘突出症,而股骨转子间骨折上升趋势最明显。③人均住院费用呈逐年上涨趋势,材料费和检查费构成比增长明显,手术费、治疗费和床位费较低,未来应研究如何“多管齐下”控制医疗费用增长和使费用构成合理化。④住院费用支付方式构成中,自费构成逐渐下降,社保构成逐渐上升,说明国家社保医疗保障范围得到进一步扩大。