加强医院感染控制与环节管理分析

目的 探讨如何强化对医院感染控制与环节管理。方法 选取2013年10月—2014年10月入住我院的患者860例作为研究对象,对其临床资料进行回顾性分析。按照管理情况分为2组,对照组428例采用常规管理,观察组432例采用重点环节管理,对比分析2组的医院感染控制效果。结果观察组总感染率为1.4%,明显低于对照组的23.6%,2组对比差异具有统计学意义(P<0.05)。结论 需强化医院感染控制与环节管理,以减少医院感染现象,减轻患者痛苦与医疗负担,同时提升医疗水平与服务质量,树立医院良好形象。     

医院感染的主要原因及管理对策

随着现代医学科技的进步,医院感染已成为评价医院综合医疗质量的重要内容。发生医院感染,既影响患者的治疗和康复,加重了社会医疗资源及个人医疗费用负担,又严重影响医疗机构的医疗质量。做好检验科的感染管理工作,对于预防职业暴露、保护检验人员的身心健康有着非常重要意义。结合《医院感染管理规范》,研究检验科医院感染管理现状,探讨预防控制措施,是保证检验质量和个人安全的重要环节。现报道如下。     

医院消毒药械的管理方法

消毒药械的管理是医院感染管理的重要环节，需要从医院领导到医院感染管理科、采购部门、库房、临床各科室的密切配合。加强各环节的管理，可有效地预防医院感染的发生，确保医疗和护理安全。我院从2006年1月起开始实施加强消毒器械的管理，取得了较好的效果，现总结报告如下。     

呼吸内科住院老年患者医院感染危险因素分析及应对措施

医院感染不仅增加患者的发病率和死亡率,而且增加了医疗工作人员的工作量,对于患者及社会的危害极大〔1〕。预防和控制医院感染是现代医院质量管理的重要内容,是提高医疗质量、保证医疗安全的重要环节。随着医疗活动中越来越多的侵入性操作,抗生素的使用等更提高了医院感染的发生率〔2〕。呼     

血液透析室的医院感染预防与控制

目的保证基层医院血液透析室医疗质量安全,加强医院感染预防和控制,降低医院感染发生率。方法对我院血液透析室2013年3月-2015年8月发生的100例院内感染临床资料进行回顾性分析。结果经临床资料分析和整理,显示危险因素包括易感因素、侵入性操作频率较高、重复使用仪器、环境因素、反复接受输血治疗、医疗垃圾。其中易感因素居于危险因素第一位。结论目前血液透析室仍存在侵入性操作频率较高、医疗垃圾处理不当等医院感染危险因素,因此临床实践中要加强医院感染管理制度、实现血液透析室合理布局、强化医院感染知识培训,制定相对应的血透室空气、水质监测等控制医院感染的对策,提高基层医院血液透析室的管理,减少医院感染的发生。     

医院灭菌物品清洗环节质量管理体会

病人用后的医疗物品污染严重，特别是器械带有血迹、脓迹、干燥的排泄物和分泌物，若不清洗干净会影响灭菌效果，可造成灭菌失败。所以清洗是减少医院感染的一个重要环节，只有选用适当的洗涤液，采用正确的洗涤方法，才能保证物品的灭菌效果。现将复用医疗灭菌物品清洗环节质量管理体会介绍如下。     

消毒供应室下收下送工作质量管理体会

目的控制工作环节质量,避免交叉感染。方法做好下送下收及工作人员的管理,严格＂洁＂＂污＂分开,专人专车,分类使用,分类存放。结果有效防止污染物品、清洁物品、无菌物品的交叉污染,保证无菌物品质量,保障医疗护理安全。结论加强消毒供应室下收下送质量管理,对预防和控制医院内感染具有重要意义。     

护理工作与医院感染控制

预防和控制医院感染是保证医疗质量和医疗安全的一项非常重要的工作,是医院护理质量的综合体现,随着医学技术的发展,医院感染防控工作面临越来越多的挑战,新的病原体、多重耐药茵感染的不断增多,侵入性诊疗技术的广泛应用,尤其是抗生素的广泛应用,使医院内感染日趋严重,医院感染的防控及管理已成为医院管理的重中之重,而多数预防医院内感染的措施均贯穿护理行为的全过程,涉及到护理工作的诸多方面,我院重视护理工作管理,注重培养高素质的护理人员,护理工作对预防医院内感染的发生,起到了重要的作用。     

病历书写质量的管理

一、病历书写质量管理的重要性 1．病历书写质量在医院管理中的重要性：病历书写质量是医院质量管理的一个重要内容,病历书写质量的优、劣,直接反映出医院各级医务人员的科学态度、严谨作风、综合素质和技术水平;同时也反映出各级医生的医疗质量和管理水平的高低,更能透视出医院的医疗服务质量和医疗管理水平。     

感染监控管理制度在控制医院感染中的作用

医院感染监控管理是当前医院医疗质量管理的一项重要内容，是一个涉及面宽、影响面大的综合概念。因此，强化医院感染监控管理既要涉及到医院管理的方方面面，包括医院建筑、组织机构建设和制度建设等，又要涉及医院感染监控设备与技术的诸多方面，包括队伍建设、检测设备和业务建设方面。这些监控管理建设的优劣都与医院感染发生关系紧密。     

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数字卫生通过构建统一标准的居民电子健康档案(EHR)、电子病历(EMR)、交互式卫生信息平台、城乡社区与医院双向转诊、远程诊疗、远程教育和健康咨询等系统达到提高医疗卫生服务质量、改善服务可及性,推进医药卫生体制改革发展,服务老百姓的健康的目标。依托"十一五"国家科技支撑计划重点项目"国家数字卫生关键技术与区域应用示范研究"项目的实施应用,浙江省已经开始数字医疗卫生探索,建立了一整套的数字医疗卫生系统,真正起到了助推医改、服务健康的技术支撑作用,对推进中国卫生事业发展意义重大。     

From Papyrus to the Electronic Tablet: A Brief History of the Clinical Medical Record with Lessons for the Digital Age

A major transition is underway in documentation of patient-related data in clinical settings with rapidly accelerating adoption of the electronic health record and electronic medical record. This article examines the history of the development of medical records in the West in order to suggest lessons applicable to the current transition. The first documented major transition in the evolution of the clinical medical record occurred in antiquity, with the development of written case history reports for didactic purposes. Benefiting from Classical and Hellenistic models earlier than physicians in the West, medieval Islamic physicians continued the development of case histories for didactic use. A forerunner of modern medical records first appeared in Paris and Berlin by the early 19th century. Development of the clinical record in America was pioneered in the 19th century in major teaching hospitals. However, a clinical medical record useful for direct patient care in hospital and ambulatory settings was not developed until the 20th century. Several lessons are drawn from the 4000-year history of the medical record that may help physicians improve patient care in the digital age.     

Advantages of computerized management in a gastrointestinal endoscopy unit

Computerized management of the activity of a gastrointestinal endoscopy unit in a hospital requires technological resources that include an intrahospital network, a computerized endoscopy program, a computerized appointments program and electronic medical records. The endoscopy unit should define the portfolio of services it provides and establish the time required to perform each procedure, probably using distinct criteria for outpatient and inpatient requests. Computerized management should establish forms designed to receive, accept and schedule requests, and should transfer all the contents of the request to the endoscopy program. The endoscopy program makes and stores reports and images. Integration among the programs allows these contents to be transferred to the electronic medical record. Measures to guarantee the confidentiality and safety of the medical information in each center should be implemented in accordance with its policy on access to medical information.     

Mortality and morbidity related to hepatitis C virus infection in hospitalized adults—A propensity score matched analysis

The World Health Organization (WHO) aims to reduce HCV mortality, but estimates are difficult to obtain. We aimed to identify electronic health records of individuals with HCV infection, and assess mortality and morbidity. We applied electronic phenotyping strategies on routinely collected data from patients hospitalized at a tertiary referral hospital in Switzerland between 2009 and 2017. Individuals with HCV infection were identified using International Classification of Disease (ICD)-10 codes, prescribed medications and laboratory results (antibody, PCR, antigen or genotype test). Controls were selected using propensity score methods (matching by age, sex, intravenous drug use, alcohol abuse and HIV co-infection). Main outcomes were in-hospital mortality and attributable mortality (in HCV cases and study population). The non-matched dataset included records from 165,972 individuals (287,255 hospital stays). Electronic phenotyping identified 2285 stays with evidence of HCV infection (1677 individuals). Propensity score matching yielded 6855 stays (2285 with HCV, 4570 controls). In-hospital mortality was higher in HCV cases (RR 2.10, 95%CI 1.64 to 2.70). Among those infected, 52.5% of the deaths were attributable to HCV (95%CI 38.9 to 63.1). When cases were matched, the fraction of deaths attributable to HCV was 26.9% (HCV prevalence: 33%), whilst in the non-matched dataset, it was 0.92% (HCV prevalence: 0.8%). In this study, HCV infection was strongly associated with increased mortality. Our methodology may be used to monitor the efforts towards meeting the WHO elimination targets and underline the importance of electronic cohorts as a basis for national longitudinal surveillance.     

柔性管理在门诊管理中的实施价值分析

目的探讨柔性管理在门诊管理中的实施价值。 方法2013年1月至2015年10月,对新疆自治区人民医院门诊部实施柔性管理模式,对实施前后门诊管理工作质量的变化进行记录与对比。 结果柔性管理实施之后,医护人员对门诊服务的满意度显著高于实施前,差异有统计学意义(P<0.05);柔性管理实施之后,门诊患者对门诊管理的满意度显著高于实施前,差异有统计学意义(P<0.05)。 结论在门诊管理工作中实施柔性管理不但可以提升医护人员的满意度,还能提升患者的满意度,从整体上提升门诊管理工作质量,值得推广。     

基于PDCA循环法的病案数字化质量控制

应用PDCA循环管理提高数字化病案质量。抽取2017年10月－2018年12月新发肿瘤手术和多次手术的病历进行病案数字化质量控制，采用PDCA循环法进行质量持续改进，数据采用excel统计分析。通过PDCA循环法对病案数字化质量控制，2017年10月－2018年12月病案数字化扫描错误发生率不断下降，效果显著。PDCA循环法对病案数字化质量控制是行之有效的管理方法。     

Pilot study of an Internet-based electronic patient treatment record and communication system for haemophilia, Advoy.com

Communication between patients and haemophilia centres is important in the management of the disease. Traditionally this has been done by paper records which give retrospective and often incomplete data. This paper describes the development and pilot study of a novel Internet-based electronic patient treatment log. The advantages of the system include up to date information available to the haemophilia centre, less data entry, better quality records and an individualized alert system for significant events. The system was tested with ten patients at three UK haemophilia centres and found to be feasible and easy to use. In the opinion of the patients and health care professionals involved in the pilot study, the system improves quality, accuracy, accessibility and usefulness of patient generated data. Development of the system is ongoing and its use extended to other haemophilia centres.     

Technology for Diabetes Care and Evaluation in the Veterans Health Administration: Harnessing Information Technologies to Improve the Delivery of Diabetes Care to Veterans: The Future Is Today

Background

Although momentum is now building nationally for improved informatics, progress has been incremental in most cases. One notable exception is the Veterans Health Administration, which utilizes one of the most widely used electronic medical record systems in the world.

Objectives

The articles in this symposium demonstrate the implementation of technology to move beyond the electronic medical record at the time of the medical encounter to improve timeliness and outcomes of care delivery for veterans with diabetes.

Results

We report on the use of electronic registries and nurse practitioner-based programs across multiple sites to improve glycemic control; the implementation of a digital retinal imaging system in primary care clinics; the use of health information technology to improve patient self-care; and the development of a research database to move beyond performance measurement to evaluate longitudinal outcomes.

Conclusions

While these articles demonstrate the ability of a single national system of care to harness the power of technology to novel strategies for the delivery of care and its evaluation, the technology is scalable from small group practices to regional health care systems.     

Direct costs of emergency medical care: a diagnosis-based case-mix classification system

STUDY OBJECTIVE: To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. DESIGN: Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. SETTING: Three community hospital EDs in Los Angeles County during selected times in 1984. MEASUREMENTS AND MAIN RESULTS: Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients versus 80% of ancillary service costs and 51% of total direct costs for admitted patients. CONCLUSION: We have developed a diagnosis-based case mix classification system for ED patient visits based on direct costs of care designed for an outpatient setting which, unlike diagnosis-related groups, includes the measurement of time-based cost for physician and nonphysician services. This classification system helps to define direct costs of hospital and physician emergency services by type of patient.